KELLY KENDRA WILSON (NPI# 1902345416) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902345416 |
| Entity Type | Individual |
| Full Name | KELLY KENDRA WILSON |
| Other Name | KELLY WHITE |
| Credential | LCSW |
| Practice Address |
3162 W Martin Luther King Blvd Ste 13-14 Fayetteville AR 72704-7679 |
| Mailing Address |
614 E Emma Ave Ste 300 Springdale AR 72764-4469 |
| Practice Telephone | 4799354834 |
| Mailing Telephone | 4797517417 |
| Mailing Fax Number | 4797514898 |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2020-06-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
8293-C | AR | Behavioral Health & Social Service Providers |
| N | 1041C0700X |
Social Worker Specialization: Clinical |
8293-M | AR | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720694086 | Kelly Wilson | Dietitian, Registered | 6865 Hitchingham Rd, Ypsilanti, MI 48197-8998 | 2020-09-21 |
| 1447736798 | Kelly Wilson | Assisted Living Facility | 8848 Gloralee St, Anchorage, AK 99502 | 2018-07-18 |
| 1992144372 | Kelly Wilson | Specialist/Technologist | 4241 Quail Hollow Cir, Cuyahoga Falls, OH 44224-5124 | 2013-06-19 |
| 1689903593 | Kelly Elizabeth Wilson | Occupational Therapist | 1522 Morris Ave, Norfolk, VA 23509-1217 | 2009-12-24 |
| 1407023591 | Kelly Wilson | Psychologist | 13875 Highway 13 S, Suite 275, Savage, MN 55378-2136 | 2008-05-08 |
| 1841330768 | Kelly Brooks Wilson | Dentist | 2201 S Blvd, Suite 210, Charlotte, NC 28203-6208 | 2007-02-08 |
| 1275688137 | Kelly L Wilson | Social Worker | 200 N Congress St, Suite 100, Jackson, MS 39201-1902 | 2007-01-23 |
| 1538255344 | Kelly E Wilson | Specialist | 7400 Fannin Suite 930, Houston, TX 77054 | 2006-10-05 |
| 1942283551 | Kelly W Wilson | Obstetrics & Gynecology | 220 East Harris Avenue, San Angelo, TX 76903 | 2005-11-29 |
| 1023646858 | Kelly Comolli Wilson | Student in an Organized Health Care Education/Training Program | Wake Forest Baptist Health Medical Center Boulevard, Winston Salem, NC 27157-0001 | 2020-03-28 |
| Street Address |
3162 W MARTIN LUTHER KING BLVD STE 13-14 |
| City | FAYETTEVILLE |
| State | AR |
| Zip Code | 72704-7679 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962865659 | Tracie Fullove | Family Medicine | 3162 W Martin Luther King Blvd Ste 13-14, Fayetteville, AR 72704-7679 | 2016-03-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598387037 | Anne-ashley Hull | Speech-Language Pathologist | 12905 Randolph Road, Fayetteville, AR 72704 | 2020-05-07 |
| 1427607019 | Destiny Bound, LLC | Midwife | 3825 N Salem Road, Fayetteville, AR 72704 | 2019-09-06 |
| 1043796881 | Travis Alexander | Physical Therapist | 3399 Black Forest Dr Ste 3, Fayetteville, AR 72704 | 2018-07-16 |
| 1104319433 | Rise Physical Therapy Pa | Clinic/Center | 3484 W Wedington Dr Ste 4, Fayetteville, AR 72704 | 2018-06-12 |
| 1346744232 | Wedington Dental, Pllc | Clinic/Center | 3500 Black Forest Drvie, Ste 1, Fayetteville, AR 72704 | 2018-03-23 |
| 1528410487 | Sharon Byrd | Licensed Practical Nurse | 17836 Harmon Rd, Fayetteville, AR 72704 | 2016-07-05 |
| 1861823502 | Andrea Warren | Pharmacist | 2875 W Martin Luther King Jr Blvd, Fayetteville, AR 72704 | 2013-12-05 |
| 1609157726 | Jessica Rose Collier | Speech-Language Pathologist | 2020 E Joyce Ave., Suite 2, Fayetteville, AR 72704 | 2011-09-02 |
| 1194044941 | Wcnc, Inc. | Skilled Nursing Facility | 4405 Persimmon Street, Fayetteville, AR 72704 | 2010-05-19 |
| 1841512944 | Jill K Johnston | Speech-Language Pathologist | 3472 N Sandpiper Dr, Fayetteville, AR 72704 | 2010-02-17 |
| Find all providers in zip 72704 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700484201 | Torrie Luciana Powell | Social Worker | 3526 Standard Dr, Fayetteville, NC 28306-8089 | 2020-10-15 |
| 1053918169 | Activelife Counseling, LLC | Social Worker | 1792 E Joyce Blvd Ste 105, Fayetteville, AR 72703-5253 | 2020-10-02 |
| 1861004996 | Roderick Eugene Brown Jr. | Social Worker | 2014 Litho Pl Ste 200, Fayetteville, NC 28304-2518 | 2020-08-19 |
| 1427667278 | Valerie Russell | Social Worker | 6209 Lakehaven Dr, Fayetteville, NC 28304-0610 | 2020-07-28 |
| 1942822671 | Alexis Oneal Vestal | Social Worker | 723 Athens Ave, Fayetteville, NC 28301-4800 | 2020-05-15 |
| 1346862281 | Heather Marie Sroka | Social Worker | 690 N Reilly Rd # F, Fayetteville, NC 28303-5724 | 2020-05-14 |
| 1952920449 | Vonetta Bethea Jackson | Social Worker | 391 Wagoner Drive, Fayetteville, NC 28303 | 2020-04-14 |
| 1730716887 | Denise Rodriguez | Social Worker | 2885 N Brookbury Xing, Fayetteville, AR 72703-4377 | 2020-03-26 |
| 1982239877 | Alicia Story | Social Worker | 3035 Boone Trail Ext, Fayetteville, NC 28304-3992 | 2020-03-11 |
| 1053959619 | Benlyd Colon | Social Worker | 2940 Breezewood Ave Ste 101-201, Fayetteville, NC 28303-5520 | 2019-12-13 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 72704 |
Please comment or provide details below to improve the information on KELLY KENDRA WILSON.
| 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.