Provider Demographics
NPI:1841740115
Name:SALLEE, KELSEY (APRN, RN)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:
Last Name:SALLEE
Suffix:
Gender:F
Credentials:APRN, RN
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:TINCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4004 MASSARD RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-6222
Mailing Address - Country:US
Mailing Address - Phone:479-434-4747
Mailing Address - Fax:
Practice Address - Street 1:4004 MASSARD RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6222
Practice Address - Country:US
Practice Address - Phone:479-434-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000210240163WP0808X
TN21946363LP0808X
AR125904363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ025784Medicaid