Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | C-6479 | AR |
NPI | 1003803321 |
---|---|
Provider Name | Kenneth B Turner |
First Address | Russellville, AR 72811-1648 |
Second Address | Russellville, AR 72801-3362 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 10/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117481001 | (05) | AR |
B69384 | (02) |