1982776936 NPI number — MR. KENNETH JOE HEARD LPC

Table of content: MR. KENNETH JOE HEARD LPC (NPI 1982776936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982776936 NPI number — MR. KENNETH JOE HEARD LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEARD
Provider First Name:
KENNETH
Provider Middle Name:
JOE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
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:
1982776936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3616 INDEPENDENCE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRYANT
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72022-7025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-231-6166
Provider Business Mailing Address Fax Number:
501-847-0008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4717 BOONE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYANT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72022-6218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-847-0008
Provider Business Practice Location Address Fax Number:
501-776-2246
Provider Enumeration Date:
11/14/2006

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: 101YP2500X , with the licence number:  P8012118 , 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)





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