Kellen William Joseph Homer, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

1201 Health Center Pkwy
Yukon, OK 73099-6381

Phone

(405) 717-6800

NPI assigned

Jul 29, 2015

Sex

Male

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 SC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Acs Primary Care Physicians - Southeast PC

  • Emergency Medicine Physician
  • Myrtle Beach, SC
  • NPI 1861430555
  Medicare reassignment

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

{
    "created_epoch": "1438128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438128000000",
    "number": "1215312442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9005 SW 38TH TER",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731793813",
            "telephone_number": "740-296-4763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 HEALTH CENTER PKWY",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730996381",
            "telephone_number": "405-717-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOMER",
        "first_name": "KELLEN",
        "middle_name": "WILLIAM JOSEPH",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-29",
        "last_updated": "2015-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Holland, APRN-CNP
• Brianna Rayne Hollis
• David Nathanael Hollrah, M.D.
• Mason Dane Holman
• Codie Homer, RBT
• Hometown Dental of Yukon PLLC
• Jaqueline Honorato Ribeiro Roa
• Christina Honza
• Sherry Leigh Hooker
• Breanna Aeileen Hoover

• Medical Physician Assistant in Yukon, OK
• Providers in Yukon, OK by specialty
• Medical Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.