MEDICARE: KEVIN GIRTMAN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1659536563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN GIRTMAN PA

Provider Business Mailing Address
First Line	:	11001 EXECUTIVE CENTER DR STE 200
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4393
Country	:	US
Telephone Number	:	501-882-3388
Fax Number	:	501-882-3300

Provider Business Practice Location Address
First Line	:	47 HIGHWAY 64 W
Second Line	:
City	:	BEEBE
State	:	AR
Zip	:	72012-9500
Country	:	US
Telephone Number	:	501-882-3388
Fax Number	:	501-882-3300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	03/31/2022

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Directions to “ KEVIN GIRTMAN PA” Practice Location

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