Provider Demographics
NPI:1821669979
Name:MARENGO, KELLI AMBER (MNSC, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:AMBER
Last Name:MARENGO
Suffix:
Gender:F
Credentials:MNSC, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST # 560
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-364-1830
Mailing Address - Fax:
Practice Address - Street 1:8 S BROADVIEW ST STE EANDF
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9601
Practice Address - Country:US
Practice Address - Phone:501-679-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR216713363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health