Kelli Lynn Blagg, FNP APN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209005102 Issued in IL

Practice address

10555 East County Road 800 N
Mattoon, IL 61938-3574

Phone

(217) 235-4227

Fax

(217) 235-4274

NPI assigned

Sep 6, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• Midwest Sinus Sleep & Allergy Associates, LLC

  • Otolaryngology Physician
  • Mount Vernon, IL
  • NPI 1962000513
  NPD (past) Authorized official
• St Louis Sinus & Sleep Centers, LLC

  • Sleep Disorder Diagnostic Clinic/Center
  • Waterloo, IL
  • NPI 1629414644
  NPD (past)

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442534400000",
    "number": "1679676738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 HAMACHER ST 205",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981592",
            "telephone_number": "618-628-0715",
            "fax_number": "888-371-4468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10555 EAST COUNTY ROAD 800 N",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619383574",
            "telephone_number": "217-235-4227",
            "fax_number": "217-235-4274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAGG",
        "first_name": "KELLI",
        "middle_name": "LYNN",
        "credential": "FNP APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-06",
        "last_updated": "2015-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209005102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00322001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lorrie A Bierman, NCC, LCPC
• Todd Bierman
• Donovan Billerman, BA
• Shelbi N Birch, APRN
• Cecil J Black, BA
• Jessica Blazich, BA
• Beverly Joyce Bledsoe, LPC, NCC, CADC
• Denise Bloemer, RD
• Robert Blood, M.D.
• Nancy Bloss

• Family Nurse Practitioner in Mattoon, IL
• Providers in Mattoon, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; 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.