Provider Demographics
NPI:1942290481
Name:CHENAULT, KATHRYN T (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:T
Last Name:CHENAULT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2501 CRESTWOOD RD
Mailing Address - Street 2:STE 204
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7616
Mailing Address - Country:US
Mailing Address - Phone:501-819-0901
Mailing Address - Fax:501-492-6478
Practice Address - Street 1:2215 WILDWOOD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5089
Practice Address - Country:US
Practice Address - Phone:501-819-0901
Practice Address - Fax:501-492-6478
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2021-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE07802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR133743001Medicaid
AR5J974Medicare ID - Type Unspecified
AR133743001Medicaid