Individual
KELLY JO HUBBARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
603 S DIVISION ST, LAVACA, AR 72941-4129
(479) 279-7700
(479) 279-7701
Mailing address
PO BOX 130, RATCLIFF, AR 72951-0130
(479) 635-5300
(479) 635-2010
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AO3428 ANP
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186319758
—
AR
05
—
200305120A
—
OK
Enumeration date
08/19/2010
Last updated
04/15/2020
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