Provider Demographics
NPI:1659081776
Name:KFORNEY
Entity Type:Organization
Organization Name:KFORNEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN-FORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-489-6560
Mailing Address - Street 1:2602 W 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6819
Mailing Address - Country:US
Mailing Address - Phone:901-352-0365
Mailing Address - Fax:901-234-5805
Practice Address - Street 1:2602 W 42ND AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6819
Practice Address - Country:US
Practice Address - Phone:901-352-0365
Practice Address - Fax:901-234-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty