Healthcare Provider Details

I. General information

NPI: 1477886109
Provider Name (Legal Business Name): ARKANSAS NEPHROLOGY & HYPERTENSION CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W 40TH AVE SUITE 7A
PINE BLUFF AR
71603-6940
US

IV. Provider business mailing address

PO BOX 2738
PINE BLUFF AR
71613-2738
US

V. Phone/Fax

Practice location:
  • Phone: 870-536-1400
  • Fax: 870-536-5196
Mailing address:
  • Phone: 870-536-1400
  • Fax: 870-536-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberE3969
License Number StateAR

VIII. Authorized Official

Name: DR. MUHAMMAD AHMER KASHIF
Title or Position: OWNER
Credential: M.D.
Phone: 870-536-1400