Kellie Jean Willis, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

120805 Issued in AR

Practice address

1701 W Clark Rd
Clarksville, AR 72830-3915

Phone

(479) 774-9290

NPI assigned

Jul 28, 2026

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1785196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785196800000",
    "number": "1083536403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 W CLARK RD",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728303915",
            "telephone_number": "479-774-9290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 W CLARK RD",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728303915",
            "telephone_number": "479-774-9290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "KELLIE",
        "middle_name": "JEAN",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-07-28",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AR",
            "license": "120805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William B. Maddox PA
• Amanda Williams, CMP
• Delores Ann Williams, LPN
• William Edward Williams, D.O.
• Glenn Willis, RECOVERY ADVOCATE
• Steven Willis, RECOVERY ADVOCATE
• Gregory Wilson
• Jesalyn Dove Wilson, PA-C
• Sarah Wilson
• Lilana Windel-Rivota

• Licensed Practical Nurse in Clarksville, AR
• Providers in Clarksville, AR by specialty
• Licensed Practical Nurse in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.