Healthcare Provider Details

I. General information

NPI: 1649192394
Provider Name (Legal Business Name): KELLY ANDREWS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MOODY DR
WHITE HALL AR
71602-9503
US

IV. Provider business mailing address

700 MOODY DR
WHITE HALL AR
71602-9503
US

V. Phone/Fax

Practice location:
  • Phone: 870-939-5329
  • Fax: 870-247-4372
Mailing address:
  • Phone: 870-939-5329
  • Fax: 870-247-4372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR079211
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: