KELLY L MALLOY (NPI# 1538448717) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538448717 |
| Entity Type | Individual |
| Full Name | KELLY L MALLOY |
| Practice Address |
1005 Balcom Ln Trumann AR 72472-9502 |
| Mailing Address |
Po Box 332 Lake City AR 72437-0332 |
| Practice Telephone | 8704831461 |
| Practice Fax Number | 8704836520 |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2011-08-05 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 373H00000X | Day Training/Habilitation Specialist | Nursing Service Related Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194239319 | Kelly Ann Malloy | Physical Therapist | 20 W Maple Ave, Merchantville, NJ 08109-5104 | 2017-11-27 |
| 1881088573 | Kelly Malloy | Physical Therapist | 811 W Evergreen Ave, Suite 306, Chicago, IL 60642-2682 | 2015-03-20 |
| 1174864987 | Kelly J Malloy | Pharmacist | 600 Court St, Fulton, MO 65251-1903 | 2013-03-05 |
| 1740414614 | Kelly Ann Malloy | Occupational Therapy Assistant | 2810 Ambassador Caffery Pkwy, Lafayette, LA 70506-5906 | 2009-05-07 |
| 1578787073 | Kelly Kathleen Malloy | Obstetrics & Gynecology | 1881 Chicago St, De Pere, WI 54115-3770 | 2007-04-13 |
| 1588792097 | Kelly Michele Malloy | Otolaryngology | 1500 E Medical Center Dr, 1st Floor Taubman Ctr Recp A, Ann Arbor, MI 48109-5312 | 2007-02-28 |
| 1598773384 | Kelly A Malloy | Optometrist | 1200 W Godfrey Ave, Philadelphia, PA 19141-3323 | 2006-08-04 |
| Street Address |
1005 BALCOM LN |
| City | TRUMANN |
| State | AR |
| Zip Code | 72472-9502 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770658338 | Jennifer Ross | Speech-Language Pathologist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2006-11-21 |
| 1013531391 | James Bradford Bates | Registered Nurse | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2020-06-03 |
| 1982240990 | Ginnie Burton | Registered Nurse | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2019-11-25 |
| 1093350712 | Mallory Grimes | Occupational Therapist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2019-11-18 |
| 1194366625 | Jennifer Elizabeth Lorince | Speech-Language Pathologist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2019-10-07 |
| 1811547268 | Tiffany Martin | Day Training/Habilitation Specialist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2019-09-18 |
| 1942859293 | Autumn Mars | Day Training/Habilitation Specialist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2019-09-10 |
| 1225683113 | Elizabeth Reed | Day Training/Habilitation Specialist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2019-08-07 |
| 1124687892 | Elizabeth Hampton | Day Training/Habilitation Specialist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2019-06-06 |
| 1457917460 | Cheryl Mcclard | Registered Nurse | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2019-05-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063039980 | First Step Arkansas, LLC | Occupational Therapist | 528 Industrial Park Access Rd, Trumann, AR 72472 | 2020-06-26 |
| 1982254710 | Brent A Davis | Physical Therapist | 516 Industrial Park Access Rd, Trumann, AR 72472 | 2019-09-13 |
| 1760992911 | Lorraine Irene Devries | Technician | 1316 Industrial Acess Drive, Trumann, AR 72472 | 2017-10-02 |
| 1902326226 | Logan Michael Schmidt | Dentist | 1711 Hwy 69 Blvd, Trumann, AR 72472 | 2017-06-27 |
| 1619228830 | Daniel Edward Ward | Case Manager/Care Coordinator | 1704 Hwy, 69, Trumann, AR 72472 | 2012-09-27 |
| 1003197542 | Mashae D. Rolland | Nurse Practitioner | 808 Highway 463 N, Trumann, AR 72472 | 2011-08-29 |
| 1982984118 | Denise Jackson | Case Manager/Care Coordinator | 1704 Highway 69, Trumann, AR 72472 | 2011-08-19 |
| 1134410467 | Dalisha Lareece Smith | Clinical Ethicist | 1704 Hwy. 69, Trumann, AR 72472 | 2011-04-20 |
| 1164727202 | Margaret Ann Peters | Case Manager/Care Coordinator | 809 West Main Suite C, Trumann, AR 72472 | 2011-01-21 |
| 1134379357 | Jeremiah Daniel Dillehay | Counselor | 170 4 Hwy. 69, Trumann, AR 72472 | 2008-09-24 |
| Find all providers in zip 72472 | ||||
| Taxonomy Code | 373H00000X |
| Grouping | Nursing Service Related Providers |
| Classification | Day Training/Habilitation Specialist |
| Individuals experienced or trained in working with developmentally disabled individuals who need assistance in acquiring and maintaining life skills that enable them to cope more effectively with the demands of independent living. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396009403 | Chasity Laire | Day Training/Habilitation Specialist | 809 W Main St Ste A, Trumann, AR 72472-2634 | 2012-07-03 |
| 1811547268 | Tiffany Martin | Day Training/Habilitation Specialist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2019-09-18 |
| 1942859293 | Autumn Mars | Day Training/Habilitation Specialist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2019-09-10 |
| 1225683113 | Elizabeth Reed | Day Training/Habilitation Specialist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2019-08-07 |
| 1124687892 | Elizabeth Hampton | Day Training/Habilitation Specialist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2019-06-06 |
| 1801327226 | Klassi Crockett | Day Training/Habilitation Specialist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2017-03-27 |
| 1326409533 | Nikki Horne | Day Training/Habilitation Specialist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2016-03-15 |
| 1639555212 | Lester Lowery | Day Training/Habilitation Specialist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2015-08-05 |
| 1013397371 | Amber Elliott-adams | Day Training/Habilitation Specialist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2015-06-02 |
| 1508253287 | Keri Jolly | Day Training/Habilitation Specialist | 1005 Balcom Ln, Trumann, AR 72472-9502 | 2015-04-21 |
| Find all providers in TRUMANN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.