Healthcare Provider Details

I. General information

NPI: 1356328520
Provider Name (Legal Business Name): ALLAN K KIRKLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 STATE HIGHWAY 22 W
DARDANELLE AR
72834-2909
US

IV. Provider business mailing address

1652 STATE HIGHWAY 22 W
DARDANELLE AR
72834-2909
US

V. Phone/Fax

Practice location:
  • Phone: 479-229-8000
  • Fax: 479-477-3924
Mailing address:
  • Phone: 479-857-8064
  • Fax: 479-477-3924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE0985
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: