Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | E-3224 | AR |
Y | 207RG0300X | Geriatric Medicine | E-3224 | AR |
NPI | 1053401521 |
---|---|
Provider Name | Oumitana Kajkenova |
First Address | Little Rock, AR 72227-3990 |
Second Address | Little Rock, AR 72227-3990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
154302001 | (05) | AR |
I05830 | (02) | |
P00105908 | RAILROAD MEDICARE (01) | AR |