Provider Demographics
NPI:1043862766
Name:SMITH, KELSEY BREANNE (APRN)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:BREANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3782 GLENBROOK LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-7856
Mailing Address - Country:US
Mailing Address - Phone:417-850-4313
Mailing Address - Fax:
Practice Address - Street 1:210 S THOMPSON ST STE 4A
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4261
Practice Address - Country:US
Practice Address - Phone:479-445-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR121402363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health