Tidwell, Kenneth Kelley

Tidwell, Kenneth Kelley is an individual health care provider with primary practice located at 225 E Jackson Ave , Jonesboro AR 72401-3119. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Tidwell, Kenneth Kelley can be contacted via phone (870) 932-0639.

Contact Information

Primary practice address
225 E Jackson Ave Jonesboro AR 72401-3119
Phone: (870) 932-0639
Fax: (870) 932-0526
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X N7857 Arkansas

Profile Details

NPI number 1942205802
LBN Legal business name Tidwell, Kenneth Kelley
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2005
Last updated Feb 15th, 2011 - about 13 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 1942205802 NPPES
Arkansas MEDICAID 117697001
Arkansas MEDICAID 208891408

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