Kelvin Vashaughn Parker Sr.
Individual provider
Active NPI
Driver · Little Rock, AR
NPI 1457945644 · NPPES record last updated Feb 27, 2021
Key facts
- NPI
- 1457945644
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 906611532 (AR)
- Practice address
- 2101 Dorchester Dr
Little Rock, AR 72204-3446
- Phone
- (501) 348-5963
- NPI assigned
- Feb 27, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|
| 906611532 | AR | MD | Driver |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Driver |
172A00000X |
906611532 |
AR |
Yes |
Addresses
Primary practice location
2101 Dorchester Dr
Little Rock, AR 72204-3446
Mailing address
2101 Dorchester Dr
Little Rock, AR 72204-3446
Phone (501) 348-5963
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 86-2265943 | Medicaid | AR | |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|
| CONNECT URL |
2232 |
Health Information Exchange (HIE) |
|