Active NPI
Kelley M Mitchell X, LPN
- Licensed Practical Nurse
- Carrier Mills, IL
National Provider Identifier
1285172395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 043075812
- Practice address
- 210 Miller Street
Carrier Mills, IL 62917 - Phone
- (618) 713-2270
- NPI assigned
- Feb 9, 2017
- 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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 043075812 | IL | Primary |
Addresses
Primary practice location
210 Miller Street
Carrier Mills, IL 62917
Mailing address
PO Box 321
210 North Miller Street
Carrier Mills, IL 62917
Phone (618) 713-2270
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 |
|---|---|---|---|
| 043075812 | IL | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486598400000",
"number": "1285172395",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 321",
"address_2": "210 NORTH MILLER STREET",
"city": "CARRIER MILLS",
"state": "IL",
"postal_code": "62917",
"telephone_number": "618-713-2270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 MILLER STREET",
"city": "CARRIER MILLS",
"state": "IL",
"postal_code": "62917",
"telephone_number": "618-713-2270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "KELLEY",
"middle_name": "M",
"name_suffix": "X",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-09",
"last_updated": "2017-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "IL",
"license": "043075812",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carrier Mills, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.