Healthcare Provider Details

I. General information

NPI: 1013486638
Provider Name (Legal Business Name): K E MANAGEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 E AUGUSTINE LN STE 7
FAYETTEVILLE AR
72703-4995
US

IV. Provider business mailing address

PO BOX 170
OZARK AR
72949-0170
US

V. Phone/Fax

Practice location:
  • Phone: 479-200-9812
  • Fax: 866-243-7203
Mailing address:
  • Phone: 866-243-7203
  • Fax: 866-243-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK JOSEPH FUOCO
Title or Position: OWNER
Credential:
Phone: 504-495-6772