Kenneth Childers P a

Primary specialty

OptometristTaxonomy code 152W00000X

License

2039 Issued in AR

Legal business name

KENNETH CHILDERS P A

Practice address

611 S Mt Olive
Siloam Springs, AR 72761

Phone

(479) 524-4231

Fax

(479) 524-8850

NPI assigned

May 7, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenneth Childers, P ANPI 1740266907

Title

Optometrist

Phone

(479) 524-4231

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenneth C Childers, PA

  • Optometrist
  • Siloam Springs, AR
  • NPI 1740266907
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223424000000",
    "number": "1407069487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 159",
            "city": "SILOAM SPRINGS",
            "state": "AR",
            "postal_code": "727610159",
            "telephone_number": "479-524-4231",
            "fax_number": "479-524-8850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 S MT OLIVE",
            "city": "SILOAM SPRINGS",
            "state": "AR",
            "postal_code": "72761",
            "telephone_number": "479-524-4231",
            "fax_number": "479-524-8850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH CHILDERS P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2008-10-08",
        "status": "A",
        "authorized_official_last_name": "CHILDERS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "479-524-4231",
        "authorized_official_credential": "P A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139158722",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "5G041",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maurice Anthony Jones, PA
• Nolan Chantry Jones
• David Raymond Jordan, PTA
• Randy James Jordan, LPC
• Kaitlyn Kear
• Kids Unlimited Learning Academy of Siloam Springs
• Kids Unlimited Learning Academy of Siloam Springs
• Matthew Scott Killingsworth, D.M.D.
• Shari K Kimball, LCSW
• Jimmy Kue

• Optometrist in Siloam Springs, AR
• Providers in Siloam Springs, AR by specialty
• Optometrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.