MEDICARE: THOMAS LYNN KENNEDY JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	E-15513	AR

General Provider Information

NPI Number	:	1396273173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS LYNN KENNEDY JR. MD

Provider Business Mailing Address
First Line	:	403 W OAK ST STE 204
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4574
Country	:	US
Telephone Number	:	870-881-9311
Fax Number	:	870-881-8588

Provider Business Practice Location Address
First Line	:	403 W OAK ST STE 204
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4574
Country	:	US
Telephone Number	:	870-881-9311
Fax Number	:	870-881-8588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2017
Last Update Date	:	02/12/2026

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