Healthcare Provider Details

I. General information

NPI: 1033855499
Provider Name (Legal Business Name): KENNETH ADAM KILGORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 N TOWN
MOUNTAIN HOME AR
72653-3105
US

IV. Provider business mailing address

614 N TOWN
MOUNTAIN HOME AR
72653-3105
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-3131
  • Fax: 870-425-3136
Mailing address:
  • Phone: 870-425-3131
  • Fax: 870-425-3136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-20150
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: