Individual
MR. ROGER O KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1100 E POPLAR ST, CLARKSVILLE, AR 72830-4419
(479) 754-5454
(479) 754-5311
Mailing address
PO BOX 738, CLARKSVILLE, AR 72830-0738
(479) 754-5454
(479) 754-5311
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C236
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59486
BX INDIVIDUAL PROVIDER #
AR
Enumeration date
08/15/2006
Last updated
07/09/2007
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