Provider Demographics
NPI:1235668575
Name:KENNEY, MICHAEL LEE (CERTIFIED PROTHETIST)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:KENNEY
Suffix:
Gender:M
Credentials:CERTIFIED PROTHETIST
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 1966
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71902-1966
Mailing Address - Country:US
Mailing Address - Phone:501-620-4800
Mailing Address - Fax:844-272-8975
Practice Address - Street 1:120 HILL ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6238
Practice Address - Country:US
Practice Address - Phone:501-620-4800
Practice Address - Fax:844-272-8975
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROPP00267224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARCP2198OtherAMERICAN BOARD FOR CERTIFICATION (NATIONWIDE)
MO1710363486Medicaid
AR213521716Medicaid
AROPP00267OtherARKANSAS DEPT OF HEALTH LICENSE
KS201241430AMedicaid