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Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 30 days.

KELLIE JEAN WILLIS LPN
NPI 1083536403
Licensed Practical Nurse in Clarksville, AR

Active since July 28, 2026
1701 W CLARK RD, CLARKSVILLE, AR 72830(479) 774-9290 Get Directions Write a Review

NPPES record added: July 28, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kellie Jean Willis Lpn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLIE JEAN WILLIS LPN (NPI 1083536403) is an individual licensed practical nurse in Clarksville, Arkansas, licensed in Arkansas (120805) and active in the NPI registry since July 2026.

NPPES Registry Identity

NPI1083536403
Entity TypeIndividualFemale
Primary Taxonomy164W00000X
Provider Legal NameKELLIE JEAN WILLISCredential: LPN
Location Address1701 W CLARK RDClarksville, AR 72830-3915
Mailing Address1701 W Clark RdClarksville, AR 72830-3915 · (479) 774-9290
Phone(479) 774-9290
Sole ProprietorNo
Enumeration DateJuly 28, 2026
NPPES CertifiedJuly 28, 2026
✔ NPI 1083536403 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers
Taxonomy Code164W00000X
License✔ Licensed in AR · 120805
Definition
A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
1701 W CLARK RD, Clarksville, AR 72830
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Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AMY REBECCA WHITE M.S., SLP
Speech-Language Pathologist
1701 W CLARK RD
CLARKSVILLE, AR 72830
Johnson County (479) 705-3200
CONSOLIDATED SCHOOL DISTRICT NO 17
Local Education Agency (LEA)
1701 W CLARK RD
CLARKSVILLE, AR 72830
Johnson County (479) 705-3200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kellie Willis's NPI number?

The NPI number for Kellie Willis is 1083536403. It was assigned to this individual provider in the NPPES registry on July 28, 2026.

Where is Kellie Willis located?

Kellie Willis practices at 1701 W Clark Rd, Clarksville, AR 72830. The listed phone number is (479) 774-9290.

What is Kellie Willis's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

When was this NPI record last updated?

The NPPES record for Kellie Willis was last updated on July 28, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.