Healthcare Provider Details

I. General information

NPI: 1316933575
Provider Name (Legal Business Name): SCOTT PRESTON KUYKENDALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 PROFESSIONAL PARK DR
CLARKSVILLE AR
72830-4432
US

IV. Provider business mailing address

23 PROFESSIONAL PARK DR
CLARKSVILLE AR
72830-4432
US

V. Phone/Fax

Practice location:
  • Phone: 479-754-4721
  • Fax: 844-584-4213
Mailing address:
  • Phone: 479-754-4721
  • Fax: 844-584-4213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC8274
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: