Provider Demographics
NPI:1851725147
Name:WILLIAMSON, KELLEY ANNETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:ANNETTE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 HIGHWAY 351
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6934
Mailing Address - Country:US
Mailing Address - Phone:870-926-4304
Mailing Address - Fax:
Practice Address - Street 1:3024 STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7415
Practice Address - Country:US
Practice Address - Phone:870-972-7153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR073500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse