MEDICARE: ANDREA L KELLAR ANP

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	363L00000X	Nurse Practitioner	A-0168	AR

General Provider Information

NPI Number	:	1215987458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA L KELLAR ANP

Provider Business Mailing Address
First Line	:	2215 WILDWOOD AVE
Second Line	:	SUITE 204
City	:	SHERWOOD
State	:	AR
Zip	:	72120-5089
Country	:	US
Telephone Number	:	501-753-2424
Fax Number	:	501-753-2733

Provider Business Practice Location Address
First Line	:	2215 WILDWOOD AVE
Second Line	:	SUITE 204
City	:	SHERWOOD
State	:	AR
Zip	:	72120-5089
Country	:	US
Telephone Number	:	501-753-2424
Fax Number	:	501-753-2733

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/28/2008

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