Provider Demographics
NPI:1174587463
Name:KAHN, NANCY (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:KAHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 WILDWOOD AVE
Mailing Address - Street 2:CAROL VICK/ADMINISTRATION
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5089
Mailing Address - Country:US
Mailing Address - Phone:501-552-7399
Mailing Address - Fax:501-552-8530
Practice Address - Street 1:2500 E 6TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3008
Practice Address - Country:US
Practice Address - Phone:501-552-4710
Practice Address - Fax:501-376-2084
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134258001Medicaid
AR134258001Medicaid
ARE84711Medicare UPIN