Kelley L Easley Dotson, APN PNP-BC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

A001612 Issued in AR

Practice address

1102 Crestwood Cir
Mena, AR 71953-5513

Phone

(479) 394-7301

Fax

(479) 394-0371

NPI assigned

May 23, 2008

Last updated

Jun 13, 2024By 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 2

Addresses

Other identifiers 1

Other names 1

• Ms. Kelley L Dotson Other 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

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
• University of Arkansas for Medical Sciences

  • Internal Medicine Physician
  • Little Rock, AR
  • NPI 1588654016
  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
• University of Arkansas for Medical Sciences

  • General Practice Dentistry
  • Little Rock, AR
  • NPI 1760843247
  NPD

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

{
    "created_epoch": "1211500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1902064272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 251418",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722251418",
            "telephone_number": "501-364-1100",
            "fax_number": "501-364-4082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 CRESTWOOD CIR",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719535513",
            "telephone_number": "479-394-7301",
            "fax_number": "479-394-0371"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Wolfe St",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722025320",
            "country_code": "US",
            "telephone_number": "501-372-2768",
            "fax_number": "501-978-6492",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EASLEY DOTSON",
        "first_name": "KELLEY",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "APN PNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-23",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AR",
            "license": "A001612",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AR",
            "license": "A001612",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "178404758",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLEY",
            "last_name": "DOTSON",
            "middle_name": "L",
            "prefix": "MS.",
            "credential": "APN PNP-BC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Delta Resilience LLC
• Diversicare Leasing Corp. (Rich Mountain Nursing and Rehabilitation Center)
• Dqhha Equipment & Supply, Inc. (Durable Medical Equipment & Supply)
• Dr J. Richard Carver, PA
• Dr. Sidney H. Simpson P. a. (Simpson Chiropractic Clinic)
• Ellison Management PLLC (Ellison Family Pharmacy)
• Ellison Management PLLC (Ellison Family Pharmacy)
• Jessica Pauline Ellison, PHARMD
• Levi Ellison, PHARMACIST
• Brian Erickson, PHARMD

• Pediatric Nurse Practitioner in Mena, AR
• Providers in Mena, 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 Jun 13, 2024; 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.