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NPI Code Detail

MEDICARE: KELLY A CARR

MEDICARE: KELLY A CARR
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
1101YM0800XMental Health Counselor
2170300000XGenetic Counselor (M.S.)
3171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1982632493
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY A CARR
Provider Business Mailing Address
First Line : 2400 S 48TH ST
Second Line :
City : SPRINGDALE
State : AR
Zip : 72762-6683
Country : US
Telephone Number : 479-750-2020
Fax Number : 479-750-4843
Provider Business Practice Location Address
First Line : 827 W HARVARD ST
Second Line :
City : SILOAM SPRINGS
State : AR
Zip : 72761-4013
Country : US
Telephone Number : 479-549-3121
Fax Number : 479-750-4843
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 03/14/2019

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