Kellie Lynn Lisenby, MNSC, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

A03042 Issued in AR

Practice address

1 Childrens Way
Slot 837
Little Rock, AR 72202-3500

Phone

(501) 364-4468

Fax

(501) 364-1516

NPI assigned

Sep 24, 2007

Last updated

Feb 15, 2011By the provider in NPPES

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 names 1

• Kellie Lynn Cyrus Former 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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Arkansas Childrens Hospital

  dba ACH Physicians Billing Group

  • Pediatrics Physician
  • Little Rock, AR
  • NPI 1598773079
  Medicare reassignment NPD
• Arkansas Childrens Professional Services Organization LLC

  • Pediatrics Physician
  • Little Rock, AR
  • NPI 1629889464
  Medicare reassignment NPD
• University of Arkansas for Medical Sciences

  dba Childrens University Medical Group

  • Pediatrics Physician
  • Little Rock, AR
  • NPI 1346230968
  Medicare reassignment NPD
• Arkansas Children's Hospital

  • Children's Hospital
  • Little Rock, AR
  • NPI 1477561983
  NPD
• University of Arkansas for Medical Sciences

  • Family Medicine Physician
  • El Dorado, AR
  • NPI 1023795051
  NPD
• University of Arkansas for Medical Sciences

  dba CUMG Psychology Services

  • Psychologist
  • Little Rock, AR
  • NPI 1114255353
  NPD

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297728000000",
    "number": "1831385772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY",
            "address_2": "SLOT 837",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-364-4468",
            "fax_number": "501-364-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY",
            "address_2": "SLOT 837",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-364-4468",
            "fax_number": "501-364-1516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISENBY",
        "first_name": "KELLIE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "MNSC, CPNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-24",
        "last_updated": "2011-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AR",
            "license": "A03042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLIE",
            "last_name": "CYRUS",
            "middle_name": "LYNN",
            "credential": "RN BSN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marlyn Lipton, LCSW
• Lisa Academy
• Brittney Denell Lisenbey
• Tonya K Lisenbey, P.T.
• Emma Lisenby
• Michelle M Lisko-Burns, M.D.
• Marquette Lison
• Rachel Lister, MHPP
• Michelle Liszewski, QBHP
• Little Rock Air Force Base Eye Care

• Pediatric Nurse Practitioner in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Pediatric Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2011; 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.