Provider Demographics
NPI:1093213357
Name:GILLEY, KELSEY DANIELLE (CNM)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:DANIELLE
Last Name:GILLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:DANIELLE
Other - Last Name:GILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5302 W VILLAGE PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8139
Mailing Address - Country:US
Mailing Address - Phone:479-372-4560
Mailing Address - Fax:
Practice Address - Street 1:5302 W VILLAGE PKWY STE 3
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8139
Practice Address - Country:US
Practice Address - Phone:479-372-4560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARM002131363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology