Healthcare Provider Details

I. General information

NPI: 1467924076
Provider Name (Legal Business Name): KELLY JEAN BETTS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3623 JOHNSON MILL BLVD STE 101
SPRINGDALE AR
72762-6412
US

IV. Provider business mailing address

17 COUNTY ROAD 511
EUREKA SPRINGS AR
72632-9417
US

V. Phone/Fax

Practice location:
  • Phone: 479-575-9359
  • Fax:
Mailing address:
  • Phone: 479-575-9359
  • Fax: 479-365-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number236451
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: