Individual
KEVIN MICHAEL LILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BSN, RN
Contact information
Practice address
2 SAINT VINCENT CIR, LITTLE ROCK, AR 72205-5423
(501) 552-2525
Mailing address
1001 MCNUTT RD LOT 33, CONWAY, AR 72034-9343
(706) 825-4856
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
R88599
AR
Other
Enumeration date
08/08/2012
Last updated
08/08/2012
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