Healthcare Provider Details

I. General information

NPI: 1891096582
Provider Name (Legal Business Name): ARNETTE LADELLE KELLEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MAIN ST
FORT WORTH TX
76104-4917
US

IV. Provider business mailing address

PO BOX 732973
DALLAS TX
75373-2973
US

V. Phone/Fax

Practice location:
  • Phone: 817-702-6500
  • Fax:
Mailing address:
  • Phone: 817-702-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number734462
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number734462
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: