Healthcare Provider Details

I. General information

NPI: 1033527387
Provider Name (Legal Business Name): KELLY FELDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 S CARAWAY RD STE M
JONESBORO AR
72401-6234
US

IV. Provider business mailing address

PO BOX 56050
LITTLE ROCK AR
72215-6050
US

V. Phone/Fax

Practice location:
  • Phone: 870-910-3757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: