Active NPI
Malory Diane Kolp, LMSW
- Social Worker
- Conway, AR
National Provider Identifier
1053028183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 11919-M
- Practice address
- 515 Oak St Ste E
Conway, AR 72032-4464 - Phone
- (501) 697-8053
- Fax
- (501) 232-4130
- NPI assigned
- Oct 28, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 11919-M | AR | Primary |
Addresses
Primary practice location
515 Oak St Ste E
Conway, AR 72032-4464
Mailing address
1156 Meadows Dr
Benton, AR 72019-8789
Phone (501) 802-4317
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 |
|---|---|---|---|
| 11919-M | AR | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666915200000",
"number": "1053028183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1156 MEADOWS DR",
"city": "BENTON",
"state": "AR",
"postal_code": "720198789",
"telephone_number": "501-802-4317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 OAK ST STE E",
"city": "CONWAY",
"state": "AR",
"postal_code": "720324464",
"telephone_number": "501-697-8053",
"fax_number": "501-232-4130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLP",
"first_name": "MALORY",
"middle_name": "DIANE",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-10-28",
"last_updated": "2022-10-28",
"certification_date": "2022-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "AR",
"license": "11919-M",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conway, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.