Provider Demographics
NPI:1467422766
Name:KING, KRISTY S (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:S
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAINT VINCENT CIR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5405
Mailing Address - Country:US
Mailing Address - Phone:501-353-2328
Mailing Address - Fax:501-353-2491
Practice Address - Street 1:1 SAINT VINCENT CIR
Practice Address - Street 2:SUITE 330
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5405
Practice Address - Country:US
Practice Address - Phone:501-353-2328
Practice Address - Fax:501-353-2491
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5874207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178494001Medicaid
ARI22758Medicare UPIN
AR178494001Medicaid