Healthcare Provider Details

I. General information

NPI: 1891507034
Provider Name (Legal Business Name): KELSIE PADDON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 N DIXIELAND RD
ROGERS AR
72756-6816
US

IV. Provider business mailing address

PO BOX 130
ROGERS AR
72757-0130
US

V. Phone/Fax

Practice location:
  • Phone: 479-986-5150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number22462M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: