Healthcare Provider Details

I. General information

NPI: 1902064272
Provider Name (Legal Business Name): KELLEY L EASLEY DOTSON APN PNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLEY L DOTSON APN PNP-BC

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 CRESTWOOD CIR
MENA AR
71953-5513
US

IV. Provider business mailing address

PO BOX 251418
LITTLE ROCK AR
72225-1418
US

V. Phone/Fax

Practice location:
  • Phone: 479-394-7301
  • Fax: 479-394-0371
Mailing address:
  • Phone: 501-364-1100
  • Fax: 501-364-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberA001612
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberA001612
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: