Provider Demographics
NPI:1992702336
Name:HEATH, KEVIN DAVID (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DAVID
Last Name:HEATH
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:PO BOX 10780
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-0013
Mailing Address - Country:US
Mailing Address - Phone:501-513-0799
Mailing Address - Fax:501-513-0798
Practice Address - Street 1:455 HOGAN LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8201
Practice Address - Country:US
Practice Address - Phone:501-513-0799
Practice Address - Fax:501-513-0798
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6835207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128137001Medicaid
AR490005155Medicare PIN
ARE61056Medicare UPIN
AR128137001Medicaid