Healthcare Provider Details

I. General information

NPI: 1104939636
Provider Name (Legal Business Name): MORRIS EUGENE KELLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 RICHARDS RD SUITE A
NORTH LITTLE ROCK AR
72117-2650
US

IV. Provider business mailing address

4000 RICHARDS RD SUITE A
NORTH LITTLE ROCK AR
72117-2650
US

V. Phone/Fax

Practice location:
  • Phone: 501-758-5133
  • Fax:
Mailing address:
  • Phone: 501-758-5133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE-3795
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: