Individual
CAROLYN SUE KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
19002 BUG SCUFFLE RD, WEST FORK, AR 72774-2878
(479) 761-0171
Mailing address
19002 BUG SCUFFLE RD, WEST FORK, AR 72774-2878
(479) 761-0171
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R089667
AR
363LF0000X
Family Nurse Practitioner
Primary
A005921
AR
Other
Enumeration date
09/13/2018
Last updated
09/26/2018
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