Provider Demographics
NPI:1043241334
Name:PRICE, KEVIN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SCOTT
Last Name:PRICE
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 1:7019 S T ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4115
Mailing Address - Country:US
Mailing Address - Phone:479-494-1980
Mailing Address - Fax:479-452-3839
Practice Address - Street 1:7019 S T ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4115
Practice Address - Country:US
Practice Address - Phone:479-494-1980
Practice Address - Fax:479-452-3839
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC81392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200101040AMedicaid
AR128547001Medicaid
AR128547001Medicaid
OK200101040AMedicaid