Healthcare Provider Details

I. General information

NPI: 1356597330
Provider Name (Legal Business Name): RYAN THOMAS KRAFFT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 MEDICAL PLZ STE 2
MOUNTAIN HOME AR
72653-2918
US

IV. Provider business mailing address

PO BOX 707
MOUNTAIN HOME AR
72654-0707
US

V. Phone/Fax

Practice location:
  • Phone: 870-424-7070
  • Fax: 870-424-6616
Mailing address:
  • Phone: 870-424-7070
  • Fax: 870-424-6616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number1656
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberE9758
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDO 5101018562
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: