Childers, Kerry K

Childers, Kerry K is an sole proprietor health care provider with primary practice located at 723 Falls Blvd S Ste A, Wynne AR 72396-3508. He recently has only one registered license in Eye and Vision Services Providers / Corneal and Contact Management, which is considered as his primary health care specialty. Childers, Kerry K can be contacted via phone (870) 238-2020.

Contact Information

Primary practice address
723 Falls Blvd S Ste A Wynne AR 72396-3508
Phone: (870) 238-2020
Fax: (870) 238-4320
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Corneal and Contact Management 152WC0802X 2038 Arkansas

Profile Details

NPI number 1114906310
LBN Legal business name Childers, Kerry K
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 16th, 2006
Last updated Mar 17th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114906310 NPPES
Arkansas MEDICAID 102042722
Arkansas Other 64772430001

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