Healthcare Provider Details

I. General information

NPI: 1922681261
Provider Name (Legal Business Name): BKD HOLDING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22461 INTERSTATE 30 S STE 301
BRYANT AR
72022-2382
US

IV. Provider business mailing address

22461 INTERSTATE 30 S STE 301
BRYANT AR
72022-2382
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-2555
  • Fax: 501-847-2250
Mailing address:
  • Phone: 501-847-2555
  • Fax: 501-847-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN DAVIDSON
Title or Position: OWNER
Credential:
Phone: 501-847-2555