Kellie Nicole Underwood

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

122078 Issued in AR

Practice address

3307 N Dixieland Rd
Rogers, AR 72756-6816

Phone

(479) 986-5150

Fax

(479) 986-5191

NPI assigned

Nov 24, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kellie Nicole Buckner Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kids for the Future Rogers, Inc.

  • Developmental Disabilities Clinic/Center
  • Rogers, AR
  • NPI 1508037870
  NPD (past)
• Kidscorp of Fayetteville, Inc

  • Developmental Disabilities Clinic/Center
  • Springdale, AR
  • NPI 1790124659
  NPD (past)

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

{
    "created_epoch": "1606176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1154925824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727570130",
            "telephone_number": "479-986-5150",
            "fax_number": "479-986-5191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3307 N DIXIELAND RD",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727566816",
            "telephone_number": "479-986-5150",
            "fax_number": "479-986-5191"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2210 Main Dr",
            "address_purpose": "LOCATION",
            "city": "Springdale",
            "state": "AR",
            "postal_code": "727626802",
            "country_code": "US",
            "telephone_number": "479-856-6397",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "UNDERWOOD",
        "first_name": "KELLIE",
        "middle_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-24",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AR",
            "license": "122078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLIE",
            "last_name": "BUCKNER",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• U Save RX, Inc.
• Katie Lyn Ubben, MS, LAC
• Bradley Robert Umbarger, MD
• Tom Umphress
• Gabriel Chad Underwood, CRNA
• Kerry Ann Underwood, MS, LPC, LMFT
• United Medical, PA
• Universal Medical Supply Corp
• Unruh Chiropractic & Wellness Center
• John J Unruh, DC

• Licensed Practical Nurse in Rogers, AR
• Providers in Rogers, 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 Nov 24, 2020; 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.