Provider Demographics
NPI:1457591687
Name:SLEEP SPECIALIST OF ARKANSAS PLLC
Entity type:Organization
Organization Name:SLEEP SPECIALIST OF ARKANSAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-305-9826
Mailing Address - Street 1:617 MARION ST
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4845
Mailing Address - Country:US
Mailing Address - Phone:501-305-9826
Mailing Address - Fax:501-279-3089
Practice Address - Street 1:617 MARION ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4845
Practice Address - Country:US
Practice Address - Phone:501-305-9826
Practice Address - Fax:501-279-3089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5148207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty