Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AO1555ANP | AR |
NPI | 1033235809 |
---|---|
Provider Name | Ms. Kelley Simon Kelly |
First Address | Sherwood, AR 72120-5804 |
Second Address | Little Rock, AR 72205-5446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |