Provider Demographics
NPI:1790454643
Name:HAMMONS, KELSIE N
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:N
Last Name:HAMMONS
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 1:5905 FOREST PL STE 230
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5265
Mailing Address - Country:US
Mailing Address - Phone:501-777-3200
Mailing Address - Fax:501-777-3202
Practice Address - Street 1:5905 FOREST PL STE 230
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5265
Practice Address - Country:US
Practice Address - Phone:501-777-3200
Practice Address - Fax:501-777-3202
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8833-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical