Provider Demographics
NPI:1538534755
Name:C. A. KUYKENDALL, INC.
Entity type:Organization
Organization Name:C. A. KUYKENDALL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUYKENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:479-667-2101
Mailing Address - Street 1:2105 CREEKVIEW
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5261
Mailing Address - Country:US
Mailing Address - Phone:479-249-9900
Mailing Address - Fax:479-249-9909
Practice Address - Street 1:2105 CREEKVIEW
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5261
Practice Address - Country:US
Practice Address - Phone:479-249-9900
Practice Address - Fax:479-249-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMG01546332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102251716Medicaid