Active NPI
Kellie Renee Bergendahl, RDH
- Dental Hygienist
- Plummer, ID
National Provider Identifier
1053563619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- DH2335
- Practice address
- 427 12TH St
Plummer, ID 83851-4000 - Phone
- (208) 686-1931
- Fax
- (208) 686-5133
- NPI assigned
- Oct 15, 2008
- Last updated
- Sep 23, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | DH2335 | ID | Primary |
Addresses
Primary practice location
427 12TH St
Plummer, ID 83851-4000
Mailing address
PO Box 994
Coeur D Alene, ID 83816-0994
Phone (208) 625-0353
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RDH 20164 | Other | CA | STATE LICENSE |
Other names 1
- Ms. Kellie R. McNeil
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DH2335 | ID | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569196800000",
"number": "1053563619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 994",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838160994",
"telephone_number": "208-625-0353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "427 12TH ST",
"city": "PLUMMER",
"state": "ID",
"postal_code": "838514000",
"telephone_number": "208-686-1931",
"fax_number": "208-686-5133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGENDAHL",
"first_name": "KELLIE",
"middle_name": "RENEE",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-15",
"last_updated": "2019-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "ID",
"license": "DH2335",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "RDH 20164",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KELLIE",
"last_name": "MCNEIL",
"middle_name": "R.",
"prefix": "MS.",
"credential": "RDH",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Plummer, ID
- Susan Mary Bates, RN
- Believe Follow Live, LLC
- Benewah Medical Center (Benewah Medical Center Pharmacy)
- Benewah Medical Center (Marimn Health)
- Benewah Medical Center (Marimn Health)
- Selene Bonnell-Hall
- Cathleen Constance Bourque, RDH
- John Bronsell Ryan Bronsell, PHARMD
- Meche Grace Brownlow, MAED, LPC
- Janet Butcher, RPT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.