Jennifer Johnson Kelly, M.D.

Key facts

NPI

1649320607

Entity type

Individual (NPI type 1)

Primary specialty

Pediatrics Physician 208000000X

License

E6540 (AR)

Practice address

245 Madison St
Clarendon, AR 72029-2706

Phone

(870) 747-3381

NPI assigned

Jan 11, 2007

Sex

Female

Sole proprietor

No

Organizations & group practices 1

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.

• Mid-Delta Health Systems Inc Federally Qualified Health Center (FQHC) · Clarendon, AR · NPI 1255346060
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jennifer.kelly@mdhs.eclinicaldirectplus.com

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 4, 2024.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712188800000",
    "number": "1649320607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 MADISON ST",
            "city": "CLARENDON",
            "state": "AR",
            "postal_code": "720292706",
            "telephone_number": "870-747-3381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 MADISON ST",
            "city": "CLARENDON",
            "state": "AR",
            "postal_code": "720292706",
            "telephone_number": "870-747-3381"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2821 Kavanaugh Blvd Ste 1C",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722053868",
            "country_code": "US",
            "telephone_number": "501-615-5733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JENNIFER",
        "middle_name": "JOHNSON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-11",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E6540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184379001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarendon, AR

• Collyn George, M.S. CCC-SLP
• Leigh Ann Guest, APN, GNP
• Marla Henry, APN
• Christopher P. Hopkinson, MD
• Nancy Hornsby, APN
• Ashley Laniece Loftis, PA-C
• Sam A. McGuire III, M.D.
• Tiffany N McPherson, BS, MHPP, LCSW
• Mid-Delta Health Systems Inc
• Mid-Delta Health Systems Inc

All providers in Clarendon, AR · Pediatrics Physician in Arkansas