Kelly Jo Hubbard, APN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AO3428 ANP Issued in AR

Practice address

603 S Division St
Lavaca, AR 72941-4129

Phone

(479) 279-7700

Fax

(479) 279-7701

NPI assigned

Aug 19, 2010

Last updated

Apr 15, 2020By the provider in NPPES

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

• Kelly Jo Hubbard Professional name

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

River Valley Primary Care ServicesGroup PAC ID 0042274276, 39 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Fort Smith Hospital, Fort Smith, AR, CCN 040062
• St Vincent Medical Center/North Hospital, Sherwood, AR, CCN 040137
• Baptist Health - Fort Smith Hospital, Fort Smith, AR, CCN 040055

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: khubbard589666@direct.ochin.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• River Valley Primary Care Services

  • Federally Qualified Health Center (FQHC)
  • Ratcliff, AR
  • NPI 1952349003
  Medicare reassignment Care Compare group NPD
• Cisterna Emergency Physicians LLC

  • Emergency Medicine Physician
  • Fort Smith, AR
  • NPI 1306178371
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baptist Health Regional Hospitals

  dba Baptist Health - Fort Smith

  • General Acute Care Hospital
  • Fort Smith, AR
  • NPI 1710463146
  Care Compare affiliation
• Mercy Hospital Fort Smith

  • General Acute Care Hospital
  • Fort Smith, AR
  • NPI 1568433480
  Care Compare affiliation
• St. Vincent Infirmary Medical Center

  dba St. Vincent Medical Center - North

  • General Acute Care Hospital
  • Sherwood, AR
  • NPI 1629011002
  Care Compare affiliation

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

{
    "created_epoch": "1282176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1780990408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "RATCLIFF",
            "state": "AR",
            "postal_code": "729510130",
            "telephone_number": "479-635-5300",
            "fax_number": "479-635-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 S DIVISION ST",
            "city": "LAVACA",
            "state": "AR",
            "postal_code": "729414129",
            "telephone_number": "479-279-7700",
            "fax_number": "479-279-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUBBARD",
        "first_name": "KELLY",
        "middle_name": "JO",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-19",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "AO3428 ANP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "186319758",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200305120A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "HUBBARD",
            "middle_name": "JO",
            "credential": "NP-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Ciara Fleer
• Ruth Ann Groff
• HNK Pharm, PLLC
• HNK Pharm, PLLC
• HNK Pharm, PLLC LTC (Health-Wise Pharmacy of Lavaca LTC)
• Lavaca Family Clinic
• Lavaca School District
• Lavaca Wellness Clinic, P.a.
• Cynthia Leach
• Little Roots Therapy, LLC (Katie Davidson)

• Family Nurse Practitioner in Lavaca, AR
• Providers in Lavaca, AR by specialty
• Family Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.