1881652345 NPI number — DANNY HANDFORD KENT D.C.

Table of content: DANNY HANDFORD KENT D.C. (NPI 1881652345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881652345 NPI number — DANNY HANDFORD KENT D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENT
Provider First Name:
DANNY
Provider Middle Name:
HANDFORD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KENT
Provider Other First Name:
DAN
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1881652345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 683
Provider Second Line Business Mailing Address:
3246 HWY 67 NORTH
Provider Business Mailing Address City Name:
WALNUT RIDGE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72476-0683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-886-2999
Provider Business Mailing Address Fax Number:
870-886-2999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3246 HIGHWAY 67
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT RIDGE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72476-8441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-886-2999
Provider Business Practice Location Address Fax Number:
870-886-2999
Provider Enumeration Date:
05/03/2006

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: 111NX0800X , with the licence number:  879 , 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: 59488 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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