Provider Demographics
NPI:1689822314
Name:KRISHT, KHALED M
Entity Type:Individual
Prefix:DR
First Name:KHALED
Middle Name:M
Last Name:KRISHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 WARDEN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-6068
Mailing Address - Country:US
Mailing Address - Phone:501-552-6400
Mailing Address - Fax:501-552-6430
Practice Address - Street 1:6020 WARDEN RD STE 100
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-6068
Practice Address - Country:US
Practice Address - Phone:501-552-6400
Practice Address - Fax:501-552-6430
Is Sole Proprietor?:No
Enumeration Date:2008-09-06
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35367207T00000X
ARE-9067207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery