Individual
KELLIE NICHOLE ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, NP-C
Contact information
Practice address
3344 N FUTRALL DR, FAYETTEVILLE, AR 72703-4057
(479) 582-7395
(479) 582-7310
Mailing address
PO BOX 550, LOWELL, AR 72745-0550
(479) 463-7775
(479) 463-7187
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A03078 ANP
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175580758
—
AR
05
—
200241820A
—
OK
01
—
5A990
AR BCBS
AR
Enumeration date
03/06/2008
Last updated
11/06/2013
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