Healthcare Provider Details

I. General information

NPI: 1396130555
Provider Name (Legal Business Name): ALICE KENNEDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICE WAN BEHRENS M.D.

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 MAIN ST
CONWAY AR
72032-5424
US

IV. Provider business mailing address

9800 BAPTIST HEALTH DR
LITTLE ROCK AR
72205-6229
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-4444
  • Fax: 501-327-3962
Mailing address:
  • Phone: 501-223-8400
  • Fax: 501-223-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberE-13990
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: