Healthcare Provider Details

I. General information

NPI: 1710186945
Provider Name (Legal Business Name): KENNETH ROY RICHARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 FRED LAGRONE DR
CROSSETT AR
71635-4546
US

IV. Provider business mailing address

104 LAKEWOOD CT
CROSSETT AR
71635-3922
US

V. Phone/Fax

Practice location:
  • Phone: 870-364-3800
  • Fax:
Mailing address:
  • Phone: 870-415-8341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE8766
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: