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:
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Health care specialties

SpecialtyCodeLicense #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 13 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922278878 NPPES
Oklahoma MEDICAID 200241820A
Oklahoma MEDICAID 175580758
Oklahoma Other 5A990
Oklahoma Other 5A990

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