Kelly R Wiley, BS MLS (ASCP)

Primary specialty

Medical TechnologistTaxonomy code 246QM0706X

License

25324986

Practice address

3200 Canyon Lake Dr
Rapid City, SD 57702-8114

Phone

(605) 355-2229

Fax

(605) 355-2514

NPI assigned

Oct 19, 2010

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science

Practice roles

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.

• Rapid City IHS Hospital

  • Clinical Medical Laboratory
  • Rapid City, SD
  • NPI 1417279175
  NPD (past)

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

{
    "created_epoch": "1287446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287446400000",
    "number": "1144530544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 CANYON LAKE DR",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577028114",
            "telephone_number": "605-355-2229",
            "fax_number": "605-355-2514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 CANYON LAKE DR",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577028114",
            "telephone_number": "605-355-2229",
            "fax_number": "605-355-2514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILEY",
        "first_name": "KELLY",
        "middle_name": "R",
        "credential": "BS MLS (ASCP)",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-19",
        "last_updated": "2010-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246QM0706X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Pathology, Medical Technologist",
            "state": null,
            "license": "25324986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0140070",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "5549050",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evelyn Iris Wilder, LPC-MH, QMHP, LAC
• Carolyn Sue Wildhaber, CSW-PIP
• Wilen Dentistry PLLC
• Kristen Miranda Wilen, MA, SLP
• Patricia Wiles, CMA
• Richard Scott Wiley, LPC-MH
• Katherine Lyford Wilgers, NP
• William a. Moss, Psy.D., LLC
• Kirsten William-Kennedy
• Roxanne Lynn William, RPH

• Medical Technologist in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Medical Technologist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2010; 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.