Healthcare Provider Details

I. General information

NPI: 1053826842
Provider Name (Legal Business Name): KELLI LAURON SLAUGHTER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLI LAURON JOHNSON

II. Dates (important events)

Enumeration Date: 12/03/2017
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PRATOR DR
ARKADELPHIA AR
71923-9706
US

IV. Provider business mailing address

1 PRATOR DR
ARKADELPHIA AR
71923-9706
US

V. Phone/Fax

Practice location:
  • Phone: 870-246-8011
  • Fax: 501-255-8145
Mailing address:
  • Phone: 870-224-6307
  • Fax: 501-255-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07171423
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: