Healthcare Provider Details

I. General information

NPI: 1154502540
Provider Name (Legal Business Name): KEVIN MEYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SKYLINE DR
RUSSELLVILLE AR
72801-3363
US

IV. Provider business mailing address

1 MEDICINE DR
CLARKSVILLE AR
72830-4431
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-2345
  • Fax: 479-890-7180
Mailing address:
  • Phone: 479-754-6510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.09302R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME73407
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-11787
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: