Healthcare Provider Details

I. General information

NPI: 1346282290
Provider Name (Legal Business Name): WILLIAM KENDRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 N SHILOH ST
SPRINGDALE AR
72764-4959
US

IV. Provider business mailing address

513 N SHILOH ST
SPRINGDALE AR
72764-3343
US

V. Phone/Fax

Practice location:
  • Phone: 479-419-9902
  • Fax: 479-419-9950
Mailing address:
  • Phone: 479-419-9902
  • Fax: 479-419-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC5417
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: