Provider Demographics
NPI:1578501300
Name:MAYHEW, KATHY LYNN (DO)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNN
Last Name:MAYHEW
Suffix:
Gender:F
Credentials:DO
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 1189
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-1189
Mailing Address - Country:US
Mailing Address - Phone:479-770-0221
Mailing Address - Fax:866-497-4412
Practice Address - Street 1:213 W MONROE AVE
Practice Address - Street 2:SUITE P
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-9451
Practice Address - Country:US
Practice Address - Phone:479-770-0221
Practice Address - Fax:866-497-4412
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131806003Medicaid
AR5K434Medicare ID - Type Unspecified
AR131806003Medicaid