Provider Demographics
NPI:1336465616
Name:MEENA, KELLEY COURTNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:COURTNEY
Last Name:MEENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:MEENA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:605 SALEM RD STE B2
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4863
Mailing Address - Country:US
Mailing Address - Phone:501-327-2444
Mailing Address - Fax:501-327-2443
Practice Address - Street 1:605 SALEM RD STE B2
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4863
Practice Address - Country:US
Practice Address - Phone:501-327-2444
Practice Address - Fax:501-327-2443
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-8079208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics