Kelly L McKerahan D O a Professional Medical Corporation

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

20A6780 Issued in CA

Legal business name

KELLY L MCKERAHAN D O A PROFESSIONAL MEDICAL CORPORATION

Practice address

25095 Jefferson Ave Ste 202
Murrieta, CA 92562-9107

Phone

(951) 696-9566

Fax

(951) 696-9536

NPI assigned

Oct 30, 2012

Organization subpart

No

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

Authorized official

Name

Kelly Lee McKerahan, D.O.NPI 1184705790

Title

Physician

Phone

(951) 696-9566

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly Lee McKerahan, D.O.

  • Family Medicine Physician
  • Murrieta, CA
  • NPI 1184705790
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352764800000",
    "number": "1508110503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25095 JEFFERSON AVE STE 202",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925629107",
            "telephone_number": "951-696-9566",
            "fax_number": "951-696-9536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25095 JEFFERSON AVE STE 202",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925629107",
            "telephone_number": "951-696-9566",
            "fax_number": "951-696-9536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY L MCKERAHAN D O A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-30",
        "last_updated": "2012-11-13",
        "status": "A",
        "authorized_official_last_name": "MCKERAHAN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "951-696-9566",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "20A6780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "GQ212A",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rosanna Keast, RN, MSN, FNP-C
• Kathleen A Keays, PA
• Katelyn Kelley, THERAPIST
• Jonathan Geoffrey Kelling, M.D.
• Kelly Kim Dental Corporation (My Kids Dentist and Orthodontics)
• Thomas Michael Kemmerly, M.D.
• Jason Anthony Kemmett
• Crista Kempisty
• Deborah L Kempston, OTR/L
• Shawn Kendrick

• Primary Care Clinic/Center in Murrieta, CA
• Providers in Murrieta, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.