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NPI Code Detail

MEDICARE: KELLIE ANN CHACANACA APRN

MEDICARE: KELLIE ANN CHACANACA APRN
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
1363LF0000XFamily Nurse PractitionerA004753AR

General Provider Information

NPI Number : 1487004461
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLIE ANN CHACANACA APRN
Provider Business Mailing Address
First Line : 2708 S RIFE MEDICAL LN STE 300
Second Line :
City : ROGERS
State : AR
Zip : 72758-1457
Country : US
Telephone Number : 479-338-3030
Fax Number : 479-338-3079
Provider Business Practice Location Address
First Line : 2708 S RIFE MEDICAL LN STE 300
Second Line :
City : ROGERS
State : AR
Zip : 72758-1457
Country : US
Telephone Number : 479-338-3030
Fax Number : 479-338-3079
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2016
Last Update Date : 06/02/2026

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