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General NPI Number Information
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NPI Number | 1154882793
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Entity Type | Individual
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Provider Name | CARMEN LYNNE KELLEY APRN
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Gender | Female
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 9601 BAPTIST HEALTH DR
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6321
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Country | US
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Telephone | 501-202-2812
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Fax |
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Provider Business Mailing Address
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Address Line | 59 WILHELMINA CV
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City | CONWAY
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State | AR
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Zip | 72034-9200
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Country | US
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Telephone | 870-830-8850
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 213270
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 163WN0002X
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Taxonomy Name | Neonatal Intensive Care Registered Nurse
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License Number | R099374
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License Number State | AR
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