Active NPI
Tyler Kellner, CPHT
- Pharmacy Technician
- Jefferson City, MO
National Provider Identifier
1295307254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 2005016326
- Practice address
- 724 W Stadium Blvd
Jefferson City, MO 65109-4772 - Phone
- (573) 635-8384
- NPI assigned
- Jul 10, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 2005016326 | MO | Primary |
Addresses
Primary practice location
724 W Stadium Blvd
Jefferson City, MO 65109-4772
Mailing address
724 W Stadium Blvd
Jefferson City, MO 65109-4772
Phone (573) 635-8384
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 |
|---|---|---|---|
| 2005016326 | MO | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625875200000",
"number": "1295307254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "724 W STADIUM BLVD",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651094772",
"telephone_number": "573-635-8384"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "724 W STADIUM BLVD",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651094772",
"telephone_number": "573-635-8384"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLNER",
"first_name": "TYLER",
"credential": "CPHT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-10",
"last_updated": "2021-07-10",
"certification_date": "2021-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "MO",
"license": "2005016326",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jefferson City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.