Basic Information
| Provider Information | |||||||||
| NPI: | 1629247747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKAY | ||||||||
| FirstName: | KRISTOPHER | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCKAY | ||||||||
| OtherFirstName: | KRIS | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4261 STOCKTON DRIVE | ||||||||
| Address2: | SUITE LL200 | ||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721172962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019757456 | ||||||||
| FaxNumber: | 5019781822 | ||||||||
| Practice Location | |||||||||
| Address1: | 4261 STOCKTON DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721172962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017917546 | ||||||||
| FaxNumber: | 5017531992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2008 | ||||||||
| LastUpdateDate: | 12/31/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | MD.31658 | AL | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZP0101X | E-6446 | AR | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZD0900X | E-6446 | AR | Y | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZP0101X | MD.31658 | AL | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.