Healthcare Provider Details

I. General information

NPI: 1396668695
Provider Name (Legal Business Name): KRISTIE KELSO-WELSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 CLEBURNE PARK RD
HEBER SPRINGS AR
72543-9106
US

IV. Provider business mailing address

74 CLEBURNE PARK RD
HEBER SPRINGS AR
72543-9106
US

V. Phone/Fax

Practice location:
  • Phone: 501-362-0943
  • Fax: 501-362-8526
Mailing address:
  • Phone: 501-362-0943
  • Fax: 501-362-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: