Kealie Kelley, LAC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

A2502019 Issued in AR

Practice address

1310 W Main St Ste 100
Russellville, AR 72801-2803

Phone

(479) 964-2011

NPI assigned

Feb 21, 2025

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

State licenses

Practice roles

Locations

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.

• Real Development Corporation

  • Community/Behavioral Health Agency
  • Russellville, AR
  • NPI 1568943140
  NPD
• Rpi Sleep Complete LLC

  • Sleep Disorder Diagnostic Clinic/Center
  • Russellville, AR
  • NPI 1942647029
  NPD (past)

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

{
    "created_epoch": "1740096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740096000000",
    "number": "1306642186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 W MAIN ST STE 201",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012803",
            "telephone_number": "479-964-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 W MAIN ST STE 100",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012803",
            "telephone_number": "479-964-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "KEALIE",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-21",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AR",
            "license": "A2502019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Ellisha Keaster, OTR/L
• Mabry Anne Keefe
• Anne A. Keenan, LCSW
• Alice L Keener
• Lindsay Keeter, LAC
• Noma Wilkinson Kellner, APRN
• Owen L Kelly, MD
• Shelby Kelly
• Krystal Kendrick
• Stephanie Kennedy, OT

• All providers in Russellville, AR
• Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2025; 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.