Basic Information
Provider Information
NPI: 1902343932
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DARNELL
FirstName: KELLIE
MiddleName: JO
NamePrefix:  
NameSuffix:  
Credential: APRN, FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2900 HAWKINS DR
Address2:  
City: SEARCY
State: AR
PostalCode: 721434802
CountryCode: US
TelephoneNumber: 5012782800
FaxNumber:  
Practice Location
Address1: 2900 HAWKINS DR
Address2:  
City: SEARCY
State: AR
PostalCode: 721434802
CountryCode: US
TelephoneNumber: 5012782800
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/28/2017
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XR069673ARN Nursing Service ProvidersRegistered Nurse 
363LF0000XA005240ARY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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