Kelli Kathleen Tate, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

2017008178 Issued in MO

Practice address

103 W Polk St
Warsaw, MO 65355-3297

Phone

(660) 438-2207

Fax

(660) 438-4304

NPI assigned

Oct 26, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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.

• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-0250

  • Community/Retail Pharmacy
  • Warsaw, MO
  • NPI 1134146467
  NPD (past)
• Wal-Mart Stores East, LP

  dba Walmart Pharmacy 10-2229

  • Pharmacy
  • Apollo Beach, FL
  • NPI 1437027208
  NPD (past)

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

{
    "created_epoch": "1603670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1376143818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 DEERRIDGE DR",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653014058",
            "telephone_number": "618-550-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 W POLK ST",
            "city": "WARSAW",
            "state": "MO",
            "postal_code": "653553297",
            "telephone_number": "660-438-2207",
            "fax_number": "660-438-4304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATE",
        "first_name": "KELLI",
        "middle_name": "KATHLEEN",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-26",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051.300969",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2017008178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Howard Steadman, DMD
• Rebecca L Steenburgen, LPC
• Sun Lakes Physical Therapy Inc
• Subashini Sundram, OTR
• Kaleem Uddin Syed, MD
• Kaetlyn Leigh Taunton, PHARMD
• Jeffrey R Tedrow, M.D.
• Linda D Tibbetts
• Cynthia Trentman, RPT
• Truman Lake Dental, LLC

• Pharmacist in Warsaw, MO
• Providers in Warsaw, MO by specialty
• Pharmacist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; 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.