Active NPI
Evan Earle Kelley, MSPT, OCS
- Specialist
- Cheyenne, WY
National Provider Identifier
1679567499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 11277
- Practice address
- 6900 Alden Dr
Cheyenne, WY 82005-3906 - Phone
- (307) 773-3406
- NPI assigned
- Sep 8, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 11277 | MA | Primary |
Addresses
Primary practice location
6900 Alden Dr
Cheyenne, WY 82005-3906
Mailing address
6900 Alden Dr
Cheyenne, WY 82005-3906
Phone (307) 773-3406
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196812800000",
"number": "1679567499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6900 ALDEN DR",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820053906",
"telephone_number": "307-773-3406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6900 ALDEN DR",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820053906",
"telephone_number": "307-773-3406"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "EVAN",
"middle_name": "EARLE",
"name_prefix": "Mr.",
"credential": "MSPT, OCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-08",
"last_updated": "2007-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MA",
"license": "11277",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cheyenne, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.