Active NPI
Lauren Alexandra Kelley
- Physical Therapist
- Willard, MO
National Provider Identifier
1386219137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2020037942
- Practice address
- 405 Farmer Rd
Willard, MO 65781-9509 - Phone
- (417) 742-0930
- NPI assigned
- May 24, 2021
- Last updated
- May 24, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2020037942 | MO | Primary |
Addresses
Primary practice location
405 Farmer Rd
Willard, MO 65781-9509
Mailing address
419 Stone Creek Rd
Willard, MO 65781-8386
Phone (870) 219-1194
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 |
|---|---|---|---|
| 2020037942 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621814400000",
"number": "1386219137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "419 STONE CREEK RD",
"city": "WILLARD",
"state": "MO",
"postal_code": "657818386",
"telephone_number": "870-219-1194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 FARMER RD",
"city": "WILLARD",
"state": "MO",
"postal_code": "657819509",
"telephone_number": "417-742-0930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "LAUREN",
"middle_name": "ALEXANDRA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-24",
"last_updated": "2021-05-24",
"certification_date": "2021-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2020037942",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willard, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 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.