Provider Demographics
NPI:1700849684
Name:KEMP, CLARENCE LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:LEONARD
Last Name:KEMP
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 1:5 MARKET PL
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-3555
Mailing Address - Country:US
Mailing Address - Phone:870-236-4001
Mailing Address - Fax:870-236-4009
Practice Address - Street 1:5 MARKET PL
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-3555
Practice Address - Country:US
Practice Address - Phone:870-236-4001
Practice Address - Fax:870-236-4009
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR03090023700OtherQUALCHOICE
AR102576001Medicaid
ARC68622Medicare UPIN
AR52829F557Medicare PIN
AR52829Medicare PIN
080117537Medicare PIN