Individual
KEVIN HANNAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4415 E FALCON DR, FAYETTEVILLE, AR 72701-7436
(479) 527-0705
Mailing address
4415 E FALCON DR, FAYETTEVILLE, AR 72701-7436
(479) 527-0705
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
R66986
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159087001
—
AR
Enumeration date
12/05/2005
Last updated
06/09/2009
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