DR. KENNETH K WALLACE (NPI# 1598737405) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598737405 |
| Entity Type | Individual |
| Full Name | DR. KENNETH K WALLACE |
| Credential | M.D. |
| Practice Address |
3000 Rogers Ave Fort Smith AR 72901-4232 |
| Practice Telephone | 4797828892 |
| Practice Fax Number | 4797828840 |
| Mailing Telephone | 4797828892 |
| Mailing Fax Number | 4797828840 |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | R2091 | AR | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | BCBS | 55462 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346548708 | Kenneth Mark Wallace Jr. | Massage Therapist | 4004 89th Ave Se, Mercer Island, WA 98040-4102 | 2011-03-09 |
| 1942342548 | Kenneth F Wallace | Dentist | 280 Mt Zion Rd, Suite D, Florence, KY 41042 | 2007-02-12 |
| 1053428680 | Kenneth Lee Wallace | Dentist | 4226 Little Rd, Arlington, TX 76016-5601 | 2006-08-23 |
| 1295791754 | Kenneth A Wallace IIi | Dermatology | 1091 Se 59th St, Ocala, FL 34480-6146 | 2006-04-25 |
| 1952787533 | Kenneth Wallace | Physical Therapy Assistant | 170 Corey Rd, Brighton House Rehabilitation and Nursing Center, Brighton, MA 02135 | 2015-08-05 |
| 1952706673 | Kenneth Wallace | Chiropractor | 119 S Park Ave, Titusville, FL 32796-3377 | 2014-10-23 |
| 1417135815 | Kenneth Ralph Wallace II | Psychologist | 3400 Warren-sharon Road, Vienna, OH 44473-9532 | 2008-02-07 |
| Street Address |
3000 ROGERS AVE |
| City | FORT SMITH |
| State | AR |
| Zip Code | 72901-4232 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619949500 | Gary V Felker | Specialist | 3000 Rogers Ave, Fort Smith, AR 72901-4232 | 2006-02-03 |
| 1952373540 | Randel L Saylor | Ophthalmology | 3000 Rogers Ave, Fort Smith, AR 72901-4232 | 2006-02-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922627249 | Vaibhav S Desai | Student in an Organized Health Care Education/Training Program | Family Medicine Uams-west, 612 South 12th St., Fort Smith, AR 72901 | 2020-04-16 |
| 1689136475 | Prudence Nassem Ipaye-adebiyi | Student in an Organized Health Care Education/Training Program | Family Medicine ; Uams-west, 612 South 12th St., Fort Smith, AR 72901 | 2019-04-02 |
| 1134608961 | Baptist Health Services | Otolaryngology | 520 Towson Ave, Suite A, Fort Smith, AR 72901 | 2018-08-13 |
| 1316426125 | Baptist Health Services | Internal Medicine | 1500 Dodson Ave Ste 60, Fort Smith, AR 72901 | 2018-08-13 |
| 1396224101 | Baptist Health Services | Internal Medicine | 1001 Towson Ave Ste 100, Fort Smith, AR 72901 | 2018-08-13 |
| 1164901914 | Baptist Health Services | Internal Medicine | 1001 Towson Ave Ste 200, Fort Smith, AR 72901 | 2018-08-13 |
| 1942789755 | Baptist Health Services | Counselor | 1001 Towson Ave Ste 500, Fort Smith, AR 72901 | 2018-08-13 |
| 1669951315 | Baptist Health Services | Family Medicine | 1500 Dodson Ave Ste 175, Fort Smith, AR 72901 | 2018-08-13 |
| 1508345265 | Baptist Health Services | Internal Medicine | 1500 Dodson Ave Ste 180, Fort Smith, AR 72901 | 2018-08-13 |
| 1326527086 | Baptist Health Services | Family Medicine | 1500 Dodson Ave Ste 195, Fort Smith, AR 72901 | 2018-08-13 |
| Find all providers in zip 72901 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700211885 | Fort Smith Neuroscience Center, Pllc. | Specialist | 7217 Cameron Park Drive, Fort Smith, AR 72903 | 2013-09-09 |
| 1699908129 | United Pain Care Fort Smith | Specialist | 3900 Rogers Avenue, Fort Smith, AR 72903 | 2009-09-01 |
| 1063650117 | John Douglas Hoffman | Specialist | 9800 Wellington Way, Fort Smith, AR 72908-9057 | 2009-01-28 |
| 1285823229 | Ft Smith Rheumatology PC | Specialist | 3501 W.e. Knight Dr, Fort Smith, AR 72903-6248 | 2007-10-16 |
| 1477749851 | Eac Anesthesia, PC | Specialist | 3502 S N St, Apartment D, Fort Smith, AR 72903-2911 | 2007-09-19 |
| 1629133053 | Perkins Orthotic and Prosthetic Lab Inc | Specialist | 910 N 32nd St, Fort Smith, AR 72903-1031 | 2006-12-26 |
| 1215035720 | Frederick Paul Feder Jr. | Specialist | 2000 S 70th St, Fort Smith, AR 72903-4036 | 2006-09-20 |
| 1619949500 | Gary V Felker | Specialist | 3000 Rogers Ave, Fort Smith, AR 72901-4232 | 2006-02-03 |
| 1679574255 | Jose A Alemparte | Specialist | 4200 Jenny Lind Rd, Suite A, Fort Smith, AR 72901-7660 | 2005-08-09 |
| 1245231828 | Gary D Fine | Specialist | 4200 Jenny Lind Road, Suite A, Fort Smith, AR 72901 | 2005-08-09 |
| Find all providers in FORT SMITH | ||||
| City | FORT SMITH |
| Zip Code | 72901 |
Please comment or provide details below to improve the information on DR. KENNETH K WALLACE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.