Provider Demographics
NPI:1215596168
Name:KELLAR, MEGAN BROOKE (APRN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:BROOKE
Last Name:KELLAR
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 1:23 WINTHROP RD
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-4311
Mailing Address - Country:US
Mailing Address - Phone:501-208-7225
Mailing Address - Fax:
Practice Address - Street 1:701 N UNIVERSITY AVE STE 201
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2936
Practice Address - Country:US
Practice Address - Phone:501-552-4763
Practice Address - Fax:501-552-4463
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR122022363LF0000X
ARR092472163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency