Kelly Jo Carter

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

17730 Star Rd
Prophetstown, IL 61277-9369

Phone

(815) 537-5973

NPI assigned

Mar 22, 2008

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 names 1

• Miss Kelly Jo Davison Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1206144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206144000000",
    "number": "1124299722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17730 STAR RD",
            "city": "PROPHETSTOWN",
            "state": "IL",
            "postal_code": "612779369",
            "telephone_number": "815-537-5973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17730 STAR RD",
            "city": "PROPHETSTOWN",
            "state": "IL",
            "postal_code": "612779369",
            "telephone_number": "815-537-5973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARTER",
        "first_name": "KELLY",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-22",
        "last_updated": "2008-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "DAVISON",
            "middle_name": "JO",
            "prefix": "MISS",
            "credential": "LPTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• James S Bleecker, DC
• Kristie L Boll, DPT
• Sherwood Donald Bryan, DDS
• Kristine Byer, FNP-C
• Amy Caldwell, SLP CCC
• Timothy S Chamberlain, M.D.
• Core Wellness Inc
• Katrina Marie Gerber, LICENSED SOCIAL WORK
• Alexander Thomas Goodwin, PHARMD
• Hartig Drug Co Corp

• All providers in Prophetstown, IL
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2008; 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.