Healthcare Provider Details

I. General information

NPI: 1134477003
Provider Name (Legal Business Name): KELLI DENTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2012
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 HIGHWAY 107
SHERWOOD AR
72120-5200
US

IV. Provider business mailing address

PO BOX 15968
LITTLE ROCK AR
72231-5968
US

V. Phone/Fax

Practice location:
  • Phone: 501-834-4174
  • Fax: 501-834-4179
Mailing address:
  • Phone: 501-221-1843
  • Fax: 501-221-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6958-C
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: