Active NPI
Jesse Blake Kitchens, D.D.S.
- General Practice Dentistry
- Clinton, AR
National Provider Identifier
1568071595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4445
- Practice address
- 465 Medical Center Pkwy
Clinton, AR 72031-7946 - Phone
- (501) 745-8811
- Fax
- (501) 745-5042
- NPI assigned
- Jul 27, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4445 | AR | Primary |
Addresses
Primary practice location
465 Medical Center Pkwy
Clinton, AR 72031-7946
Mailing address
465 Medical Center Pkwy
Clinton, AR 72031-7946
Phone (501) 745-8811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4445 | AR | MD | General Practice Dentistry |
Interoperability endpoints
- jesse.kitchens@bmrhc.eclinicaldirectplus.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595808000000",
"number": "1568071595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "465 MEDICAL CENTER PKWY",
"city": "CLINTON",
"state": "AR",
"postal_code": "720317946",
"telephone_number": "501-745-8811",
"fax_number": "501-475-5042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "465 MEDICAL CENTER PKWY",
"city": "CLINTON",
"state": "AR",
"postal_code": "720317946",
"telephone_number": "501-745-8811",
"fax_number": "501-745-5042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KITCHENS",
"first_name": "JESSE",
"middle_name": "BLAKE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-27",
"last_updated": "2020-07-27",
"certification_date": "2020-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AR",
"license": "4445",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.