Kelley, Manuel R
Kelley, Manuel R is an individual health care provider with primary practice located at 1101 Tennessee St , Pine Bluff AR 71601-5801. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Kelley, Manuel R can be contacted via phone (870) 543-2380.Contact Information
Primary practice address
1101 Tennessee St
Pine Bluff AR 71601-5801
Phone: (870) 543-2380
Fax: (870) 535-4716
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | C-5328 | Arkansas |
Profile Details
| NPI number | 1083670830 |
|---|---|
| LBN Legal business name | Kelley, Manuel R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 21st, 2006 |
| Last updated | Sep 29th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083670830 | NPPES |
| Arkansas | Other | 1159400000 | QUAL CHOICE |
| Arkansas | Other | 52821 | QUAL CHOICE |
| Arkansas | Other | 0120403 | QUAL CHOICE |
| Arkansas | MEDICAID | 103173001 | QUAL CHOICE |
| Arkansas | Other | C68619 | QUAL CHOICE |
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