Jennifer Kelly, PD

Primary specialty

PharmacistTaxonomy code 183500000X

License

PD09944 Issued in AR

Practice address

202 South Livermore
Hazen, AR 72064

Phone

(870) 255-4403

Fax

(870) 255-3772

NPI assigned

Jan 8, 2021

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 identifiers 1

Other names 1

• Jennifer Kelly Professional 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.

• Prescription Shop Hazen LLC

  • Community/Retail Pharmacy
  • Hazen, AR
  • NPI 1477688463
  NPD
• Prescription Shop Hazen LLC LTC

  • Long Term Care Pharmacy
  • Hazen, AR
  • NPI 1912734211
  NPD

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

{
    "created_epoch": "1610064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610064000000",
    "number": "1528656121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 507",
            "city": "HAZEN",
            "state": "AR",
            "postal_code": "720640507",
            "telephone_number": "870-255-3433",
            "fax_number": "870-255-3772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 SOUTH LIVERMORE",
            "city": "HAZEN",
            "state": "AR",
            "postal_code": "72064",
            "telephone_number": "870-255-4403",
            "fax_number": "870-255-3772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "PD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-08",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "PD09944",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1477688463",
            "identifier": "1477688463",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "KELLY",
            "credential": "PD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Cherie Spence Dulany, MS/LPE
• Rachel Hardke, PHARMD
• Hazen School District
• Hazen SNF Operator LLC
• Mary Alison Kee, APRN
• Allison Kreimeier, MS, RD, CSSD
• Amanda G Owens, MSW, LCSW
• Prescription Shop Hazen LLC
• Prescription Shop Hazen LLC LTC
• Laura Shores, RD, LD

• Pharmacist in Hazen, AR
• Providers in Hazen, AR by specialty
• Pharmacist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2021; 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.