Active NPI
Shannon Kelly Miller, RDH
- Dental Hygienist
- Oquawka, IL
National Provider Identifier
1841801099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 020.011534
- Practice address
- 1204 Hwy 164 E
Oquawka, IL 61469 - Phone
- (309) 867-2770
- Fax
- (309) 867-3205
- NPI assigned
- Aug 12, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 020.011534 | IL | Primary |
Addresses
Primary practice location
1204 Hwy 164 E
Oquawka, IL 61469
Mailing address
PO Box 129 Oquawka Il 61469
111 S. 10TH St. Oquawka Il 61469
Oquawka, IL 61469
Phone (319) 759-6644
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020.011534 | IL | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597190400000",
"number": "1841801099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 129 OQUAWKA IL 61469",
"address_2": "111 S. 10TH ST. OQUAWKA IL 61469",
"city": "OQUAWKA",
"state": "IL",
"postal_code": "61469",
"telephone_number": "319-759-6644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1204 HWY 164 E",
"city": "OQUAWKA",
"state": "IL",
"postal_code": "61469",
"telephone_number": "309-867-2770",
"fax_number": "309-867-3205"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "SHANNON",
"middle_name": "KELLY",
"name_prefix": "Mrs.",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-12",
"last_updated": "2020-08-12",
"certification_date": "2020-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "IL",
"license": "020.011534",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oquawka, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.