Cheri W Kelly, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085001319 Issued in IL

Practice address

7 S Hospital Dr
Murphysboro, IL 62966-3333

Phone

(618) 687-3418

NPI assigned

Jan 5, 2007

Last updated

Sep 13, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shawnee Health Service and Development Corp

  dba Shawnee Health Care, Carbondale

  • Federally Qualified Health Center (FQHC)
  • Carbondale, IL
  • NPI 1073745345
  NPD (past)
• Shawnee Health Service and Development Corp

  dba Shawnee Health Care, Carterville

  • Federally Qualified Health Center (FQHC)
  • Carterville, IL
  • NPI 1811928732
  NPD (past)
• Shawnee Health Service and Development Corp

  dba Marion Wellness

  • Federally Qualified Health Center (FQHC)
  • Marion, IL
  • NPI 1881624161
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347494400000",
    "number": "1053469387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 577",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629180577",
            "telephone_number": "618-956-9540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 S HOSPITAL DR",
            "city": "MURPHYSBORO",
            "state": "IL",
            "postal_code": "629663333",
            "telephone_number": "618-687-3418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CHERI",
        "middle_name": "W",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2012-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085001319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "085001319",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "CF3444",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "132564",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370966854002",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370966854005",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Kalaher, O.D.
• Kaleidoscope Connections, Inc.
• Amy Nelson Karg, M.S., CCC/SLP
• Ruth Karnes, LCSW
• Tali Kasser, NCSP, LCP
• Sherry Ann Kirkman
• Mary Ann Kohring, NP
• Kroger Limited Partnership I (Kroger Pharmacy)
• Thomas William Kupferer, D.O.
• Valerie Ann Kupferer, D.O.

• Medical Physician Assistant in Murphysboro, IL
• Providers in Murphysboro, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.