Provider Demographics
NPI:1619162179
Name:KEMPER, LANCE BRADEN (PA)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:BRADEN
Last Name:KEMPER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 FAIRVIEW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-8664
Mailing Address - Country:US
Mailing Address - Phone:012-780-2685
Mailing Address - Fax:
Practice Address - Street 1:114 FAIRVIEW LAKE DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-8664
Practice Address - Country:US
Practice Address - Phone:012-780-2685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARGL-013363A00000X
ARPA-314363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPA-314OtherMEDICAL LICENSE