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Contact Information

KENNETH CHILDERS P A
611 S MT OLIVE
SILOAM SPRINGS, AR72761
 Phone: 479-524-4231
 Fax: 479-524-8850
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for KENNETH CHILDERS P A · (Female)

NPI Number 1407069487
Status Active
Credentials
Entity Individual
Enumeration date 05/07/2007
Last updated 10/08/2008 - About 18 years ago
Sole proprietor 1 Not specified
Identifiers
  • AR License # 2039
  • AR Medicaid 139158722
  • AR Other 5G041 MEDICARE GROUP PTAN
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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