Kenneth Kelley Tidwell in Jonesboro - Diagnostic Radiology

Kenneth Kelley Tidwell - NPI 1942205802

Kenneth Kelley Tidwell is a Diagnostic Radiology in Jonesboro, Arkansas. Kenneth Kelley Tidwell practices all healthcare services and medical treatments related to Diagnostic Radiology. The NPI Number for Kenneth Kelley Tidwell is 1942205802. The last update date is 2011-02-15.

Kenneth Kelley Tidwell's current location address is 800 S Church St Ste 101, Jonesboro, Arkansas. You can contact this provider via phone number 8709320639 and fax number 8709320526. The mailing address for Kenneth Kelley Tidwell is 800 S Church St Ste 101, Jonesboro, Arkansas. To know further, please read the information below!

Provider Profile Detail

Provider Name Kenneth Kelley Tidwell
Address 800 S Church St Ste 101, Jonesboro, Arkansas
Phone Number 8709320639
Fax Number 8709320526
Sole Proprietor N
Credentials M.D.

NPI Number Detail

NPI Number 1942205802
Provider Enumeration Date 2005-06-16
Last Updated Date 2011-02-15

Provider Mailing Address Detail

Address 800 S Church St Ste 101
City Jonesboro
State Arkansas (AR)
Post Code 7240141540
Phone Number 8709320639
Fax Number 8709320526

Provider's Primary Taxonomy Detail

Speciality Diagnostic Radiology
Taxonomy 2085R0202X
Licence No N7857
Definition:
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Provider's Other Legacy Identifiers

Identifier Identifier Type Identifier State Identifier Issuer
117697001 AR --
208891408 MO --

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FAQs about Kenneth Kelley Tidwell

What is the unique 10-digit identifier code issued to Kenneth Kelley Tidwell by the Centers for Medicare & Medicaid Services?

The Kenneth Kelley Tidwell has been assigned the NPI (National Provider Identifier) 1942205802 by the CMS (Centers for Medicare & Medicaid Services). This 10-digit code serves as a unique identification number for healthcare providers.

Could you kindly provide the complete physical address where Kenneth Kelley Tidwell's facilities are geographically located?

The facilities of Kenneth Kelley Tidwell are physically situated at the following location: 800 S Church St Ste 101, Jonesboro, AR, 7240141540.

What is Kenneth Kelley Tidwell's specialized field of practice, and what is the corresponding taxonomy code that categorizes this area of expertise?

The area of specialization for Kenneth Kelley Tidwell is Diagnostic Radiology, and the taxonomy code that classifies this field of practice is 2085R0202X.

On what date did the Kenneth Kelley Tidwell receive the assignment of its 1942205802 from the Centers for Medicare & Medicaid Services?

The Kenneth Kelley Tidwell was issued its 1942205802 by the Centers for Medicare & Medicaid Services on 2005-06-16.

When was the information regarding Kenneth Kelley Tidwell most recently updated?

The details pertaining to the Kenneth Kelley Tidwell, including its address, specialty, and other relevant information, were last refreshed on 2011-02-15.

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