Provider Demographics
NPI:1053037770
Name:KION PEDIATRICS
Entity type:Organization
Organization Name:KION PEDIATRICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:I
Authorized Official - Last Name:NWOKEJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-560-5466
Mailing Address - Street 1:11 SOUTHPOINTE DRIVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450
Mailing Address - Country:US
Mailing Address - Phone:870-560-5466
Mailing Address - Fax:870-336-1027
Practice Address - Street 1:11 SOUTHPOINTE DRIVE
Practice Address - Street 2:SUITE K
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450
Practice Address - Country:US
Practice Address - Phone:870-560-5466
Practice Address - Fax:870-336-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty