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General NPI Number Information
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NPI Number | 1619162179
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Entity Type | Individual
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Provider Name | LANCE BRADEN KEMPER PA
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Gender | Male
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 114 FAIRVIEW LAKE DR
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City | SEARCY
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State | AR
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Zip | 72143-8664
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Country | US
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Telephone | 12-780-2685
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Fax |
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Provider Business Mailing Address
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Address Line | 114 FAIRVIEW LAKE DR
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City | SEARCY
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State | AR
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Zip | 72143-8664
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Country | US
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Telephone | 12-780-2685
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | GL-013
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-314
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License Number State | AR
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