Provider Demographics
NPI:1164473468
Name:SMITH, KELLYE A (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLYE
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KELLYE
Other - Middle Name:C
Other - Last Name:MCELROY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:594 E MILLSAP RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4096
Mailing Address - Country:US
Mailing Address - Phone:479-442-2020
Mailing Address - Fax:
Practice Address - Street 1:594 E MILLSAP RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4096
Practice Address - Country:US
Practice Address - Phone:479-442-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7313207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR52206Medicare ID - Type Unspecified
C68452Medicare UPIN
AR122861001Medicare ID - Type Unspecified