Provider Demographics
NPI:1790068773
Name:CAMP, KELLI MICHELE (DNP, APN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:MICHELE
Last Name:CAMP
Suffix:
Gender:F
Credentials:DNP, APN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 MALLARD POINT RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-7082
Mailing Address - Country:US
Mailing Address - Phone:870-404-6709
Mailing Address - Fax:870-607-0057
Practice Address - Street 1:555 W 6TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3409
Practice Address - Country:US
Practice Address - Phone:870-425-8288
Practice Address - Fax:870-425-8299
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03609363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily