Provider Demographics
NPI:1154502540
Name:MEYER, KEVIN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICINE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-4431
Mailing Address - Country:US
Mailing Address - Phone:479-754-6510
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICINE DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4431
Practice Address - Country:US
Practice Address - Phone:479-754-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73407208600000X
LAMD.09302R208600000X
ARE-11787208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184417001Medicaid
FL41948OtherBCBS
FL252221100Medicaid
LA1993158Medicaid
LA5U542CX79Medicare PIN
FL252221100Medicaid