Individual
MS. KELLY ANN LUEDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMS, PA-C
Contact information
Practice address
2110 W WALNUT ST, ROGERS, AR 72756-3246
(479) 202-7035
Mailing address
2110 W WALNUT ST, ROGERS, AR 72756-3246
(479) 202-7035
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1191
OK
363A00000X
Physician Assistant
Primary
PA-443
AR
363AM0700X
Medical Physician Assistant
2009009834
MO
363AM0700X
Medical Physician Assistant
PA-443
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100768880I
—
OK
05
—
100768880J
—
OK
01
—
5V349
AR BC/BS
AR
Enumeration date
05/26/2006
Last updated
06/26/2024
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