Healthcare Provider Details

I. General information

NPI: 1154882793
Provider Name (Legal Business Name): CARMEN LYNNE KELLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR
LITTLE ROCK AR
72205-6321
US

IV. Provider business mailing address

59 WILHELMINA CV
CONWAY AR
72034-9200
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-2812
  • Fax:
Mailing address:
  • Phone: 870-830-8850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number213270
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberR099374
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: