Doctor Name: | KELLIE MANES |
NPI Number: | 1043611502 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN |
License Number: | R091282 |
Business Practice Address: | 823 N Main St Harrison, AR - 726012914 |
Business Phone Number: | 8707412960 |
Business Fax Number: | |
Mailing Address: | 823 N Main St, HARRISON |
State: | AR |
Postal Code: | 726012914 |
Phone Number: | 8707412960 |
Fax Number: | |
NPI Enumeration Date: | 09/15/2014 |
NPI Last Update Date: | 09/15/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WP0807X |
License Number: | R091282 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Psych/Mental Health, Child & Adolescent |
Taxonomy Definition: |