Provider Demographics
NPI:1679571723
Name:COLLINS, KENNETH PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:PAUL
Last Name:COLLINS
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 1:520 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3528
Mailing Address - Country:US
Mailing Address - Phone:870-741-8286
Mailing Address - Fax:870-741-2895
Practice Address - Street 1:520 N SPRING ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3528
Practice Address - Country:US
Practice Address - Phone:870-741-8286
Practice Address - Fax:870-741-2895
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123224001Medicaid
AR55824Medicare ID - Type Unspecified
AR123224001Medicaid