Healthcare Provider Details

I. General information

NPI: 1376870923
Provider Name (Legal Business Name): JERRI LYNN KAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 RIVERFRONT DR
LITTLE ROCK AR
72202
US

IV. Provider business mailing address

PO BOX 17085
NORTH LITTLE ROCK AR
72117-0085
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-6965
  • Fax: 501-603-0675
Mailing address:
  • Phone: 501-837-1416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberO-T0974
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: