Kelly Elizabeth Weller

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

443 Oak Grove Cir
Wauconda, IL 60084-3904

Phone

(224) 456-3601

NPI assigned

Aug 5, 2019

Last updated

Aug 5, 2019By the provider in NPPES

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

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

{
    "created_epoch": "1564963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564963200000",
    "number": "1558916858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "443 OAK GROVE CIR",
            "city": "WAUCONDA",
            "state": "IL",
            "postal_code": "600843904",
            "telephone_number": "224-456-3601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "443 OAK GROVE CIR",
            "city": "WAUCONDA",
            "state": "IL",
            "postal_code": "600843904",
            "telephone_number": "224-456-3601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLER",
        "first_name": "KELLY",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-05",
        "last_updated": "2019-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wauconda Healthcare & Rehabilitation Centre, LLC
• Wauconda Pharmacy Inc
• Wauconda Pharmacy, Inc. (Vital Care of Wauconda)
• Wauconda Physical Therapy, Inc.
• Ahmad Wehbi
• West Suburban Vision Care Inc.
• Rebecca Joy Westrate, FNP-C
• Stacie Wharton, PA
• Mary M Williams, COTA/L
• Derek Wolken, FNP

• Student in an Organized Health Care Education/Training Program in Wauconda, IL
• Providers in Wauconda, IL by specialty
• Student in an Organized Health Care Education/Training Program in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; 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.