Kenneth Childers P A

LBN: Kenneth Childers P A
Kenneth Childers P A is an health care organization with primary practice located at 611 S Mt Olive , Siloam Springs AR 72761. The organization recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as the primary health care specialty. Kenneth Childers P A can be contacted via phone (479) 524-4231, or through Childers, Kenneth via phone (479) 524-4231.

Contact Information

Primary practice address
611 S Mt Olive Siloam Springs AR 72761
Phone: (479) 524-4231
Fax: (479) 524-8850
Website:
Map and Directions
Authorized official contact:
Name: Childers, Kenneth Physician Assistant (PA)
Phone: (479) 524-4231

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2039 Arkansas

Profile Details

NPI number 1407069487
LBN Legal business name Kenneth Childers P A
DBA Doing business as
Authorized official Childers, Kenneth Physician Assistant (PA)
Entity Organization
Organization subpart 1 No
Enumeration date May 7th, 2007
Last updated Oct 8th, 2008 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407069487 NPPES
Arkansas MEDICAID 139158722
Arkansas Other 5G041

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