Robertson, Kellie Nichole
Robertson, Kellie Nichole is an individual health care provider with primary practice located at 3344 N Futrall Dr , Fayetteville AR 72703-4057. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Robertson, Kellie Nichole can be contacted via phone (479) 582-7395.Contact Information
Primary practice address
3344 N Futrall Dr
Fayetteville AR 72703-4057
Phone: (479) 582-7395
Fax: (479) 582-7310
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | A03078 ANP | Arkansas |
Profile Details
| NPI number | 1922278878 |
|---|---|
| LBN Legal business name | Robertson, Kellie Nichole |
| Credentials | MSN, NP-C |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 6th, 2008 |
| Last updated | Nov 6th, 2013 - about 11 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 | 1922278878 | NPPES |
| Oklahoma | MEDICAID | 200241820A | |
| Oklahoma | MEDICAID | 175580758 | |
| Oklahoma | Other | 5A990 | |
| Oklahoma | Other | 5A990 |
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