Kelli B Krill

Key facts

NPI

1043374747

Entity type

Individual (NPI type 1)

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Practice address

425 Broadway St
Paducah, KY 42001-0713

Phone

(270) 442-7121

NPI assigned

Dec 20, 2006

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 24, 2009.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235433600000",
    "number": "1043374747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 BROADWAY",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "42001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 BROADWAY ST",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420010713",
            "telephone_number": "270-442-7121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRILL",
        "first_name": "KELLI",
        "middle_name": "B",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-20",
        "last_updated": "2009-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Paducah, KY · Mental Health Clinic/Center (Including Community Mental Health Center) in Kentucky