MEDICARE: KELSEY L.M. MCCLELLAN MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	E-8895	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457679011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY L.M. MCCLELLAN MD

Provider Business Mailing Address
First Line	:	124 W CAPITOL AVE
Second Line	:	SUITE 1900
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-3704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 W CAPITOL AVE
Second Line	:	SUITE 1900
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-3704
Country	:	US
Telephone Number	:	404-888-6494
Fax Number	:

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

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	08/24/2015

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