Jana Kelly

Key facts

NPI

1962665729

Entity type

Individual (NPI type 1)

Primary specialty

Speech-Language Pathologist 235Z00000X

Practice address

1000 Lakeshore St
Glenwood, AR 71943-9127

Phone

(870) 356-3206

NPI assigned

Jul 2, 2008

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 2, 2008.

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214956800000",
    "number": "1962665729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 SCOTTLAND LN",
            "city": "BISMARCK",
            "state": "AR",
            "postal_code": "719297271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 LAKESHORE ST",
            "city": "GLENWOOD",
            "state": "AR",
            "postal_code": "719439127",
            "telephone_number": "870-356-3206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-02",
        "last_updated": "2008-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131122721",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Glenwood, AR · Speech-Language Pathologist in Arkansas