Childers, Kenneth C
Childers, Kenneth C is an sole proprietor health care provider with primary practice located at 611 S Mount Olive St , Siloam Springs AR 72761-3603. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Childers, Kenneth C can be contacted via phone (479) 524-4231.Contact Information
Primary practice address
611 S Mount Olive St
Siloam Springs AR 72761-3603
Phone: (479) 524-4231
Fax: (479) 524-8850
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2039 | Arkansas |
Profile Details
| NPI number | 1740266907 |
|---|---|
| LBN Legal business name | Childers, Kenneth C |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 20th, 2005 |
| Last updated | Jun 2nd, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1740266907 | NPPES |
| Arkansas | MEDICAID | 139158722 |
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