Wallace, Kenneth K
Wallace, Kenneth K is an individual health care provider with primary practice located at 3000 Rogers Ave , Fort Smith AR 72901-4232. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Wallace, Kenneth K can be contacted via phone (479) 782-8892.Contact Information
Primary practice address
3000 Rogers Ave
Fort Smith AR 72901-4232
Phone: (479) 782-8892
Fax: (479) 782-8840
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | R2091 | Arkansas |
Profile Details
| NPI number | 1598737405 |
|---|---|
| LBN Legal business name | Wallace, Kenneth K |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 3rd, 2006 |
| Last updated | Jul 8th, 2007 - about 17 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1598737405 | NPPES |
| Arkansas | Other | 55462 | BCBS |
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