Healthcare Provider Details

I. General information

NPI: 1962948075
Provider Name (Legal Business Name): KAELYN EVE LAY MSN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SPRINGHILL DR
NORTH LITTLE ROCK AR
72117-2922
US

IV. Provider business mailing address

3333 SPRINGHILL DR
NORTH LITTLE ROCK AR
72117-2922
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-3000
  • Fax:
Mailing address:
  • Phone: 501-202-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004969
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA004969
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: