Kelly Sue Hargis
Individual provider Active NPI Contractor · Marshall, IL
NPI 1508151192 · NPPES record last updated Jun 13, 2011
Key facts
- NPI
- 1508151192
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 24994 E Fishback Rd
Marshall, IL 62441-4695 - Phone
- (217) 264-5355
- NPI assigned
- Jun 13, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
24994 E Fishback Rd
Marshall, IL 62441-4695
Mailing address
24994 E Fishback Rd
Marshall, IL 62441-4695
Phone (217) 264-5355
Other providers in Marshall, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.