Provider Demographics
NPI:1598099632
Name:NWOKEJI, KRIS I (MD)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:I
Last Name:NWOKEJI
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 1:1117 MCLAIN ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-3500
Mailing Address - Country:US
Mailing Address - Phone:870-523-3518
Mailing Address - Fax:
Practice Address - Street 1:1117 MCLAIN ST
Practice Address - Street 2:SUITE 600
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3500
Practice Address - Country:US
Practice Address - Phone:870-523-3518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6275208000000X
NJ25MA08563700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5AA64Medicare PIN