1821519240 NPI number — KALEB E HARP DDS

Table of content: KALEB E HARP DDS (NPI 1821519240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821519240 NPI number — KALEB E HARP DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARP
Provider First Name:
KALEB
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821519240
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1848
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71953-1841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-710-8220
Provider Business Mailing Address Fax Number:
501-620-4600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1723 MALVERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-710-8220
Provider Business Practice Location Address Fax Number:
501-620-4144
Provider Enumeration Date:
07/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4238 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 023112200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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