Healthcare Provider Details

I. General information

NPI: 1023239241
Provider Name (Legal Business Name): RICHARD ERIN MCKELVEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FORT ROOTS DR
NORTH LITTLE ROCK AR
72114-1709
US

IV. Provider business mailing address

6 LORINE CIR
LITTLE ROCK AR
72205-2531
US

V. Phone/Fax

Practice location:
  • Phone: 510-257-3984
  • Fax:
Mailing address:
  • Phone: 501-944-7962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberE-5270
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: