Provider Demographics
NPI:1942591896
Name:KELTON, WENDY JO (APN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JO
Last Name:KELTON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:1113 CHESTNUT STREET
Mailing Address - City:LEWISVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71845-0367
Mailing Address - Country:US
Mailing Address - Phone:870-921-5744
Mailing Address - Fax:870-921-5733
Practice Address - Street 1:1113 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:AR
Practice Address - Zip Code:71845-0367
Practice Address - Country:US
Practice Address - Phone:870-921-5744
Practice Address - Fax:870-921-5733
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03509363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health