Active NPI
Mary Eileen Kelly
- Dental Hygienist
- Little Rock Afb, AR
National Provider Identifier
1033867924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 3151
- Practice address
- 1090 Arnold Dr
Little Rock Afb, AR 72099-4933 - Phone
- (501) 987-7304
- NPI assigned
- Mar 10, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | DH16312 | FL | |
| Dental Hygienist | 124Q00000X | 3151 | AR | Primary |
Addresses
Primary practice location
1090 Arnold Dr
Little Rock Afb, AR 72099-4933
Mailing address
1090 Arnold Dr
Little Rock Afb, AR 72099-4933
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3151 | AR | MD | General Practice Dentistry |
| DH16312 | FL | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651622400000",
"number": "1033867924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1090 ARNOLD DR",
"city": "LITTLE ROCK AFB",
"state": "AR",
"postal_code": "720994933"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1090 ARNOLD DR",
"city": "LITTLE ROCK AFB",
"state": "AR",
"postal_code": "720994933",
"telephone_number": "501-987-7304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "MARY",
"middle_name": "EILEEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-10",
"last_updated": "2022-05-04",
"certification_date": "2022-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "FL",
"license": "DH16312",
"primary": false
},
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "AR",
"license": "3151",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Rock Afb, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.