Doctor Name: | BRENDA KELLEY |
NPI Number: | 1003895251 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PTA1770 |
License Number: | PTA1770 |
Business Practice Address: | 1003 Evergreen Dr Jonesboro, AR - 724019783 |
Business Phone Number: | 8708868715 |
Business Fax Number: | 8708862653 |
Mailing Address: | 1003 Evergreen Dr, JONESBORO |
State: | AR |
Postal Code: | 724019783 |
Phone Number: | 8708868715 |
Fax Number: | 8708862653 |
NPI Enumeration Date: | 01/14/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | PTA1770 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |