Provider Demographics
NPI:1609823780
Name:DANKS, KELLY RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:RICHARD
Last Name:DANKS
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 1:1706 E JOYCE BLVD
Mailing Address - Street 2:2
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5238
Mailing Address - Country:US
Mailing Address - Phone:479-521-0900
Mailing Address - Fax:479-521-7284
Practice Address - Street 1:1706 E JOYCE BLVD
Practice Address - Street 2:2
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5238
Practice Address - Country:US
Practice Address - Phone:479-521-0900
Practice Address - Fax:479-521-7284
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0433207T00000X
TXH7718207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
5J641Medicare ID - Type Unspecified
A03401Medicare UPIN