Provider Demographics
NPI:1881829380
Name:ALLISON, KELLIE A (ETC)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:A
Last Name:ALLISON
Suffix:
Gender:F
Credentials:ETC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 W SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-3510
Mailing Address - Country:US
Mailing Address - Phone:501-206-4514
Mailing Address - Fax:
Practice Address - Street 1:1008 TRAILWOOD DR
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-9212
Practice Address - Country:US
Practice Address - Phone:501-250-7039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR050109850206E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide