Healthcare Provider Details

I. General information

NPI: 1558867309
Provider Name (Legal Business Name): KIRBY N VON EDWINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 BAPTIST HEALTH DR STE 600
LITTLE ROCK AR
72205-6231
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-7596
  • Fax: 501-978-1959
Mailing address:
  • Phone: 501-227-7596
  • Fax: 501-978-1959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE-17815
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-17815
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: