MEDICARE: KELSEY NUTT APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	124584	AR

General Provider Information

NPI Number	:	1053275263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY NUTT APRN, FNP-C

Provider Business Mailing Address
First Line	:	2824 HAYNESVILLE HWY
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-9721
Country	:	US
Telephone Number	:	870-831-1676
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 THOMPSON AVE STE A
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4464
Country	:	US
Telephone Number	:	870-864-8010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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