Individual
ELICIA KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9601 INTERSTATE 630 EXIT 7, LITTLE ROCK, AR 72205-7202
(501) 202-4000
Mailing address
904 AUTUMN RD, STE. 500, LITTLE ROCK, AR 72211-3702
(501) 202-4209
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
C7147
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112798001
—
AR
Enumeration date
08/30/2006
Last updated
05/19/2008
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