Carolyn Sue Kelley, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

A005921 Issued in AR

Practice address

19002 Bug Scuffle Rd
West Fork, AR 72774-2878

Phone

(479) 761-0171

NPI assigned

Sep 13, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

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

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.

• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

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

{
    "created_epoch": "1536796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537920000000",
    "number": "1811470974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19002 BUG SCUFFLE RD",
            "city": "WEST FORK",
            "state": "AR",
            "postal_code": "727742878",
            "telephone_number": "479-761-0171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19002 BUG SCUFFLE RD",
            "city": "WEST FORK",
            "state": "AR",
            "postal_code": "727742878",
            "telephone_number": "479-761-0171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "CAROLYN",
        "middle_name": "SUE",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-13",
        "last_updated": "2018-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A005921",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AR",
            "license": "R089667",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elana Marie Hillbrand
• Rachel Holland
• Kelley Humbard, OT
• Jennifer Joe, COTA
• William Chandler Joe, PTA
• Caroline Marie Kyle
• Melanie Krisanne Kyle, BCBA
• Hannah Lyons
• Taylor Mae Massey, COTA/L
• Shannon Medina

• Family Nurse Practitioner in West Fork, AR
• Providers in West Fork, 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 Sep 26, 2018; 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.