Kellie Merideth Davison, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6554-C Issued in AR

Practice address

6127 Highway 49 N Ste D
Brookland, AR 72417-8650

Phone

(870) 219-7450

NPI assigned

Sep 25, 2008

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 2

Other names 1

• Mrs. Kellie Merideth Taylor Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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.

• Courage Counseling

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Brookland, AR
  • NPI 1093390064
  NPD Authorized official
• Families, Inc. of Arkansas

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pocahontas, AR
  • NPI 1275623035
  NPD (past)
• Families, Inc. of Arkansas

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Paragould, AR
  • NPI 1386728681
  NPD (past)

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

{
    "created_epoch": "1222300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619740800000",
    "number": "1679723795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6127 HIGHWAY 49 N STE D",
            "city": "BROOKLAND",
            "state": "AR",
            "postal_code": "724178650",
            "telephone_number": "870-336-2937",
            "fax_number": "870-336-2938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6127 HIGHWAY 49 N STE D",
            "city": "BROOKLAND",
            "state": "AR",
            "postal_code": "724178650",
            "telephone_number": "870-219-7450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 Morgan St",
            "address_2": "Suite 8",
            "address_purpose": "LOCATION",
            "city": "Paragould",
            "state": "AR",
            "postal_code": "724503949",
            "country_code": "US",
            "telephone_number": "870-335-9483",
            "fax_number": "870-335-9487",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVISON",
        "first_name": "KELLIE",
        "middle_name": "MERIDETH",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-25",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "6554-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5AR15",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173840795",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Brookland",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Phone",
            "address_1": "6127 Highway 49 N Ste D",
            "city": "Brookland",
            "state": "AR",
            "country_code": "US",
            "postal_code": "724178650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLIE",
            "last_name": "TAYLOR",
            "middle_name": "MERIDETH",
            "prefix": "MRS.",
            "credential": "PLMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Childrens Home for Life Foundation
• Melissa Conaway, MCD, SLP
• Converge Therapy, LLC
• Courage Counseling
• Kimberly A Crosland, BCBA-D
• Madeline M Dent
• Amanda Dickerson, COTA/L
• Megan Elizabeth Etter, ATC
• First Step Arkansas, LLC
• Flight Pediatric Therapy, LLC

• All providers in Brookland, AR
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.