Provider Demographics
NPI:1780033001
Name:GEOFFRION, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:GEOFFRION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 OZARKA COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-6455
Mailing Address - Country:US
Mailing Address - Phone:870-269-2110
Mailing Address - Fax:
Practice Address - Street 1:1 LAUBACH DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450
Practice Address - Country:US
Practice Address - Phone:870-568-5195
Practice Address - Fax:870-292-3580
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician