# KENNETH A HEILES, D.O. PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003040213
- **Authorized official:** DR. KENNETH A HEILES D.O (OWNER/PHYSICIAN)
- **Authorized official phone:** (870) 628-5110

## Contact information

- **Practice address:** 203 S JEFFERSON ST, STAR CITY, AR 71667-5101
- **Practice address phone:** (870) 628-5110
- **Practice address fax:** (870) 628-5949
- **Mailing address:** PO BOX 310, MOUNTAIN HOME, AR 72654-0310
- **Mailing address phone:** (870) 628-5110
- **Mailing address fax:** (870) 628-5949

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | R3681 | AR | Yes |

## Other

- **Enumeration date:** 05/04/2009
- **Last updated:** 09/28/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 112297003 | — | AR |