Healthcare Provider Details

I. General information

NPI: 1164346839
Provider Name (Legal Business Name): KELLI S QUINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S ROCKINGCHAIR RD
PARAGOULD AR
72450-3771
US

IV. Provider business mailing address

1300 S ROCKINGCHAIR RD
PARAGOULD AR
72450-3771
US

V. Phone/Fax

Practice location:
  • Phone: 870-236-6439
  • Fax: 870-239-0680
Mailing address:
  • Phone: 870-236-6439
  • Fax: 870-239-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR089687
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: