Basic Information
| Provider Information | |||||||||
| NPI: | 1699215079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | KELI | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | P.A. (PA-C) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3633 CENTRAL AVE STE N | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016236100 | ||||||||
| FaxNumber: | 5016236187 | ||||||||
| Practice Location | |||||||||
| Address1: | 3633 CENTRAL AVE | ||||||||
| Address2: | STE. N | ||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016236100 | ||||||||
| FaxNumber: | 5016236187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2017 | ||||||||
| LastUpdateDate: | 09/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PA718 | 01 | AR | STATE LICENSE | OTHER | 568770ZXSZ | 01 | AR | MEDICARE | OTHER |