Maryalice Kelly, APN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

A001933 Issued in AR

Practice address

1125 N College Ave
Fayetteville, AR 72703-1908

Phone

(479) 713-8000

Fax

(479) 443-3903

NPI assigned

Jul 7, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680825600000",
    "number": "1326071283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 251420",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722251420",
            "telephone_number": "501-686-8000",
            "fax_number": "501-526-5148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 N COLLEGE AVE",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727031908",
            "telephone_number": "479-713-8000",
            "fax_number": "479-443-3903"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2422 N Thompson St",
            "address_purpose": "LOCATION",
            "city": "Springdale",
            "state": "AR",
            "postal_code": "727641757",
            "country_code": "US",
            "telephone_number": "479-750-6566",
            "fax_number": "479-750-5251",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MARYALICE",
        "name_prefix": "Ms.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2023-04-07",
        "certification_date": "2023-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AR",
            "license": "A001933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182728758",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melanie Kelley, RN
• Ross Eugene Kelley, M.S. LPC
• Kellie E Barnes DDS PLLC
• Natasha Victoria Kellogg, DNP, APRN, FNP-BC
• Allicia K Kelly, O.D.
• Randi Kelly, AAS, QBHP
• Sierra August Kelly
• Kim Kemery, COTA
• William B Kendall, MD
• Carl Kendrick, M.D.

• Nurse Practitioner in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.