Kori Dawn Keylon, PA, RT

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

6739286-1206 Issued in UT

Practice address

1478 East Highway 162
Montezuma Creek, UT 84534-0130

Phone

(435) 651-3700

Fax

(435) 678-0608

NPI assigned

Jan 14, 2014

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

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Utah Navajo Health System IncorporatedGroup PAC ID 1658275649, 47 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• Utah Navajo Health System, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Montezuma Creek, UT
  • NPI 1811991151
  Medicare reassignment Care Compare group NPD
• Utah Navajo Health System, Incorporated

  • Family Medicine Physician
  • Blanding, UT
  • NPI 1457489486
  NPD (past)
• Utah Navajo Health System, Incorporated

  • Land Ambulance
  • Montezuma Creek, UT
  • NPI 1598198434
  NPD (past)

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

{
    "created_epoch": "1389657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646870400000",
    "number": "1134541972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "MONTEZUMA CREEK",
            "state": "UT",
            "postal_code": "845340130",
            "telephone_number": "435-651-3700",
            "fax_number": "435-651-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1478 EAST HIGHWAY 162",
            "city": "MONTEZUMA CREEK",
            "state": "UT",
            "postal_code": "845340130",
            "telephone_number": "435-651-3700",
            "fax_number": "435-678-0608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEYLON",
        "first_name": "KORI",
        "middle_name": "DAWN",
        "credential": "PA, RT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-14",
        "last_updated": "2022-03-10",
        "certification_date": "2022-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "6739286-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adrian Christopher Harman, RPH
• Jessica Stubbs Hayes, LMFT
• Richard Lee Hendy, LCSW
• Emily Elizabeth Hunter, PHARMD
• Emilie J Johnson, APRN, FNP-C
• Angela Dawn Konecki, PHARMD
• Roselyn Maryboy, LCSW
• Casey Kent McCullough, M.D.
• Lindsey Rae McGarry, PHD
• Eugene L Meyer, RPH

• Medical Physician Assistant in Montezuma Creek, UT
• Providers in Montezuma Creek, UT by specialty
• Medical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.