Healthcare Provider Details

I. General information

NPI: 1023441474
Provider Name (Legal Business Name): KELLY MONEY BSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6263 HIGHWAY 49S
PARAGOULD AR
72450
US

IV. Provider business mailing address

4103 REYNOLD'S PARK RD
PARAGOULD AR
72450
US

V. Phone/Fax

Practice location:
  • Phone: 870-240-0444
  • Fax: 870-240-0466
Mailing address:
  • Phone: 870-476-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: