Kelly M Churchill, AUD, CCC-A

Primary specialty

AudiologistTaxonomy code 231H00000X

License

1807 Issued in NM

Practice address

4351 E Lohman Ave Ste 103
Las Cruces, NM 88011-8258

Phone

(575) 521-9795

NPI assigned

Oct 5, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Kelly M Frost Former name

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Advanced Hearing Care, LLC

  • Audiologist
  • Las Cruces, NM
  • NPI 1386902773
  Medicare reassignment NPD

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562025600000",
    "number": "1538256375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4351 E LOHMAN AVE STE 103",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880118258",
            "telephone_number": "575-521-9795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4351 E LOHMAN AVE STE 103",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880118258",
            "telephone_number": "575-521-9795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCHILL",
        "first_name": "KELLY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "AUD, CCC-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2019-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NM",
            "license": "1807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "K2358",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "FROST",
            "middle_name": "M",
            "prefix": "DR.",
            "credential": "AUD, CCC-A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Audiologist in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Audiologist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2019; 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.