Provider Demographics
NPI:1255688016
Name:KEMP, JUSTIN (APRN)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:KEMP
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MARKET PL
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-3555
Mailing Address - Country:US
Mailing Address - Phone:870-236-4001
Mailing Address - Fax:870-236-4009
Practice Address - Street 1:5 MARKET PL
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-3555
Practice Address - Country:US
Practice Address - Phone:870-236-4001
Practice Address - Fax:870-236-4009
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-12
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR195270758Medicaid
AR195270758Medicaid