Healthcare Provider Details

I. General information

NPI: 1104876341
Provider Name (Legal Business Name): ELAINE M KEMP PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 CANAL AVE E
WYNNE AR
72396-3004
US

IV. Provider business mailing address

2707 BROWNS LANE
JONESBORO AR
72401
US

V. Phone/Fax

Practice location:
  • Phone: 870-587-7020
  • Fax: 870-587-7020
Mailing address:
  • Phone: 870-972-4939
  • Fax: 870-972-4911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number05-02P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: