Provider Demographics
NPI:1992079917
Name:KENNETH C. PRATHER, M.D., P.A.
Entity type:Organization
Organization Name:KENNETH C. PRATHER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRATHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-881-4550
Mailing Address - Street 1:5500 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-8525
Mailing Address - Country:US
Mailing Address - Phone:870-881-4550
Mailing Address - Fax:870-881-4550
Practice Address - Street 1:460 W OAK
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-8525
Practice Address - Country:US
Practice Address - Phone:870-864-5490
Practice Address - Fax:870-864-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5928208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty