Kelley L Maughon, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

2002022036 Issued in MO

Practice address

98 Medical Dr
Hannibal, MO 63401-6885

Phone

(573) 406-1301

Fax

(573) 406-0511

NPI assigned

Feb 1, 2007

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

Other identifiers 4

Other names 1

• Kelley L Munroe Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Northeast Missouri Ambulatory Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Hannibal, MO
  • NPI 1710982699
  NPD (past)

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393977600000",
    "number": "1811035231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 511",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634010511",
            "telephone_number": "573-406-1301",
            "fax_number": "573-406-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 MEDICAL DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016885",
            "telephone_number": "573-406-1301",
            "fax_number": "573-406-0511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAUGHON",
        "first_name": "KELLEY",
        "middle_name": "L",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-01",
        "last_updated": "2014-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "6003A",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2002022036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MO BLUE SHIELD",
            "identifier": "175118",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARK BLUE SHIELD",
            "identifier": "83410",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "917229908",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158119001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLEY",
            "last_name": "MUNROE",
            "middle_name": "L",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mark Twain Oxygen & Medical Equipment LLC
• Janell Dianne Martin, CRNA
• Julie A Martinson
• Sherry L Masterson, FNP
• Melissa Matrisch, MD
• Maxwell Pharmacy, Inc.
• Shay M Mayer, PLPC
• Stephanie McAfee
• Mandy J. McAllister, FNP-C
• Olivia McBride

• Certified Registered Nurse Anesthetist in Hannibal, MO
• Providers in Hannibal, MO by specialty
• Certified Registered Nurse Anesthetist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2014; 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.