Healthcare Provider Details

I. General information

NPI: 1942155502
Provider Name (Legal Business Name): ARIELLE ELIZABETH KELLY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 S SILVER SPRINGS RD
CAPE GIRARDEAU MO
63703-7539
US

IV. Provider business mailing address

639 S SILVER SPRINGS RD
CAPE GIRARDEAU MO
63703-7539
US

V. Phone/Fax

Practice location:
  • Phone: 573-702-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025053132
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: