Individual
KELVIN VASHAUGHN PARKER SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2101 DORCHESTER DR, LITTLE ROCK, AR 72204-3446
(501) 348-5963
Mailing address
2101 DORCHESTER DR, LITTLE ROCK, AR 72204-3446
(501) 348-5963
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
906611532
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86-2265943
—
AR
Enumeration date
02/27/2021
Last updated
02/27/2021
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