Individual
DR. KENNETH MARCUS POEMOCEAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1102 JACKSON ST SW, GRAVETTE, AR 72736-9121
(479) 787-5221
(479) 787-5613
Mailing address
1101 JACKSON ST SW, GRAVETTE, AR 72736-9121
(479) 787-5221
(479) 787-5613
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
N8028
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100096320A
—
OK
01
—
100726240D
OK GROUP MEDICAID NUMBER
OK
05
—
117997001
—
AR
05
—
202892501
—
MO
01
—
54175
BCBS (AR)
AR
01
—
P00298552
RAILROAD MEDICARE
AR
Enumeration date
05/02/2006
Last updated
10/16/2023
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