Provider Demographics
NPI:1699215079
Name:HALL, KELI E (PA (PA-C))
Entity Type:Individual
Prefix:
First Name:KELI
Middle Name:E
Last Name:HALL
Suffix:
Gender:F
Credentials:PA (PA-C)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3633 CENTRAL AVE STE N
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6475
Mailing Address - Country:US
Mailing Address - Phone:501-623-6100
Mailing Address - Fax:501-623-6187
Practice Address - Street 1:3633 CENTRAL AVE
Practice Address - Street 2:STE. N
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6475
Practice Address - Country:US
Practice Address - Phone:501-623-6100
Practice Address - Fax:501-623-6187
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPA718OtherSTATE LICENSE
AR568770ZXSZOtherMEDICARE