SOUTNAKHON PHANDANOUVONG (APRN) – Family Nurse Practitioner, NPI 1780273250

SOUTNAKHON PHANDANOUVONG (APRN) is a healthcare provider. based in Van buren, Arkansas. specializing in NURSE PRACTITIONER. They hold the professional credentials APRN. They hold a License No. 214525 (AR). The NPI Number for SOUTNAKHON PHANDANOUVONG (APRN) is 1780273250

Main info

Female
2 Years Of Experience
Accepts Medicare Assignment
Name
SOUTNAKHON PHANDANOUVONG (APRN)
NPI
1780273250
Phone
(479) 459-0046
Address
5728 KIBLER RD
Enumeration Date
11 January 2021
Last Update Date
5 June 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4792084601
Graduation Year
2024 (2 years ago)
PAC ID
2163837949
Group Practice PAC ID
2769838812
Professional Enrollment ID
I20210209002792
Address ID
AR729047028FO4300XAVEX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience34
Completeness75
Years active:5State licenses:1Digital endpointsOther names

3,434 NURSE PRACTITIONER in AR

Provider Addresses for SOUTNAKHON PHANDANOUVONG (APRN)

  • 5728 KIBLER RD

    VAN BUREN, AR 729567576

    Phone: (479) 459-0046

    Type: Mailing

  • 4300 GRAND AVE

    FORT SMITH, AR 729047028

    Phone: (479) 208-4601

    Type: Location

  • 1101 SUNNYSIDE RD

    ALMA, AR 729217301

    Phone: (479) 459-0046

    Type: Mailing

  • 421 N MAIN ST

    MULBERRY, AR 729478574

    Phone: (479) 997-1484

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 11 Open Payments records for all available years, with a total value of $485.

Total Amount is formed as General ($485) + Research ($0) + Ownership ($0) = $485.

Last reported payment date: 2024-11-07 • Largest payer in this snapshot: ABBVIE INC. ($438).

Total Amount

$485

General + Research + Ownership

Payments

11

Total payment records

General Amount

$485

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-11-07

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-06-05

PECOS data refreshed: 2026-06-15

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20210209002792INurse PractitionerARTBD
I20250605000483INurse PractitionerOKTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
36415Insertion of needle into vein for collection of blood sample9364$0
80061Blood test, lipids (cholesterol and triglycerides)7459$0
83036Hemoglobin a1c level6944$0
81003Automated urinalysis test3426$0
82044Urine microalbumin (protein) analysis2020$0
View full utilization report →

Insurance plans in this area (ZIP 72956)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2769838812View full group profile
NameSpecialtyState
Nurse PractitionerAR
Internal Medicine, Critical Care (Intensivists), Pulmonary DiseaseAR
Nurse PractitionerAR

Reviews

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Frequently asked questions

What is the 10-digit NPI for SOUTNAKHON PHANDANOUVONG (APRN)?
SOUTNAKHON PHANDANOUVONG (APRN) — NPI 1780273250 — is the standard way to identify this listing.
Is SOUTNAKHON PHANDANOUVONG (APRN) listed as active for patients and plans?
The listing shows SOUTNAKHON PHANDANOUVONG (APRN) as active in the NPI system.
What is SOUTNAKHON PHANDANOUVONG (APRN) best known for clinically?
Directory data describes SOUTNAKHON PHANDANOUVONG (APRN) with Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What area does SOUTNAKHON PHANDANOUVONG (APRN) serve?
SOUTNAKHON PHANDANOUVONG (APRN)'s listing highlights Van Buren, Arkansas; more addresses can appear in NPPES.
How many locations tie to this NPI?
4 practice locations appear in the available data.

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