Individual
KELLY KNOLLMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2710 RIFE MEDICAL LN, ROGERS, AR 72758-1452
(479) 338-8000
(913) 381-0979
Mailing address
PO BOX 291264, NASHVILLE, TN 37229-1264
(913) 642-4900
(913) 381-0979
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
C01545
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
C01545
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5Y795
BCBS OF ARKANSAS
AR
Enumeration date
07/05/2006
Last updated
06/09/2017
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