Healthcare Provider Details

I. General information

NPI: 1689012056
Provider Name (Legal Business Name): KENNETH ARNOLD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E SEVIER ST
BENTON AR
72015-3934
US

IV. Provider business mailing address

307 E SEVIER ST
BENTON AR
72015-3934
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-4224
  • Fax: 501-776-0411
Mailing address:
  • Phone: 501-315-4224
  • Fax: 501-776-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: