St. Clair, Kevin L

St. Clair, Kevin L is an individual health care provider with primary practice located at 4375 N Vantage Dr Suite 305, Fayetteville AR 72703-4982. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Dermatology. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. St. Clair, Kevin L can be contacted via phone (479) 443-5100.

Contact Information

Primary practice address
4375 N Vantage Dr Suite 305 Fayetteville AR 72703-4982
Phone: (479) 443-5100
Fax: (479) 443-5117
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X R4149 Arkansas
Allopathic & Osteopathic Physicians / Dermatology 207N00000X R-4149 Arkansas

Profile Details

NPI number 1649357690
LBN Legal business name St. Clair, Kevin L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 1st, 2006
Last updated Nov 18th, 2021 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649357690 NPPES
Arkansas MEDICAID 119113001
Arkansas Other 16085000000

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