Individual
KENNETH L HOLDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
264 SOUTHWEST DR, JONESBORO, AR 72401-5829
(870) 336-2976
(870) 931-0665
Mailing address
264 SOUTHWEST DR, JONESBORO, AR 72401-5829
(870) 336-2976
(870) 931-0665
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-7966
AR
208D00000X
General Practice Physician
E-7966
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000044326
BCBS PROVIDER NUMBER
—
01
—
32062
LICENSE
KY
05
—
64320625
—
KY
01
—
E-7966
LICENSE
AR
Enumeration date
09/16/2006
Last updated
07/27/2021
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