Healthcare Provider Details

I. General information

NPI: 1275054215
Provider Name (Legal Business Name): BRIAN KENNEDY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HIGHWAY 65 S
CLINTON AR
72031-6588
US

IV. Provider business mailing address

2500 HIGHWAY 65 S
CLINTON AR
72031-6588
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-7000
  • Fax:
Mailing address:
  • Phone: 501-745-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2017022156
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: