Healthcare Provider Details

I. General information

NPI: 1427722651
Provider Name (Legal Business Name): KENLEE FAITH HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 HOPE LANDING RD
EL DORADO AR
71730-8725
US

IV. Provider business mailing address

214 HOPE LANDING RD
EL DORADO AR
71730-8725
US

V. Phone/Fax

Practice location:
  • Phone: 870-862-0500
  • Fax:
Mailing address:
  • Phone: 870-862-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA4671
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: