MEDICARE: KATHRYN T CHENAULT 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	2084N0400X	Neurology Physician	E0780	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942290481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN T CHENAULT MD

Provider Business Mailing Address
First Line	:	2501 CRESTWOOD RD
Second Line	:	STE 204
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7616
Country	:	US
Telephone Number	:	501-819-0901
Fax Number	:	501-492-6478

Provider Business Practice Location Address
First Line	:	2215 WILDWOOD AVE
Second Line	:	SUITE 200
City	:	SHERWOOD
State	:	AR
Zip	:	72120-5089
Country	:	US
Telephone Number	:	501-819-0901
Fax Number	:	501-492-6478

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	12/17/2021

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