Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Kenneth Jake Sample, MD

Individual provider Internal Medicine Physician · NPI 1699358960

Dr. Kenneth Jake Sample, MD is an Internal Medicine in Gravette, Arkansas. Qualified in 2021, 5 years ago. Practices with Sgoh Acquisition Inc, a 93-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Arkansas.

Years since qualifying
5
Licensed in
AR
In the registry since
2021
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

1101 Jackson St SW
Gravette, AR 72736-9121
Phone: (479) 787-5221
Fax: (479) 787-5613
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 346 N Main St, Decatur, AR 72722-9732 — (479) 752-3233
  • 920 Madison Ave Ste 447, Memphis, TN 38103-3438 — (901) 448-5814

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence E-18299 (AR)

Record details

NPI number1699358960
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 4, 2021
Last updated in NPPESAugust 5, 2024
Certification dateAugust 5, 2024
Mailing address1101 Jackson St Sw, Gravette, AR 72736-9121

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Sgoh Acquisition Inc — 93 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Gravette