Carolyn D. Kissiar, CNP

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

209001132 Issued in IL

Practice address

37 Rustic Campus Drive
Southern Seven Health Department
Ullin, IL 62992-2226

Phone

(618) 634-2297

Fax

(618) 634-9011

NPI assigned

Mar 24, 2010

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 names 1

• Carolyn D. Mueller Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Practitioner

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.

• Southern Seven Health Dept

  • Health Service Clinic/Center
  • Ullin, IL
  • NPI 1255499463
  NPD (past)

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

{
    "created_epoch": "1269388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269388800000",
    "number": "1861716532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 RUSTIC CAMPUS DRIVE",
            "city": "ULLIN",
            "state": "IL",
            "postal_code": "629922226",
            "telephone_number": "618-634-2297",
            "fax_number": "618-634-9011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 RUSTIC CAMPUS DRIVE",
            "address_2": "SOUTHERN SEVEN HEALTH DEPARTMENT",
            "city": "ULLIN",
            "state": "IL",
            "postal_code": "629922226",
            "telephone_number": "618-634-2297",
            "fax_number": "618-634-9011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISSIAR",
        "first_name": "CAROLYN",
        "middle_name": "D.",
        "name_prefix": "Mrs.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-24",
        "last_updated": "2010-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041244469",
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "IL",
            "license": "209001132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "MUELLER",
            "middle_name": "D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cierra Nicole Adkins, MA, CF-SLP
• County of Pulaski School District No.100
• Aaron Hale, ED.S.
• Caroline Suesann Hayes, ED.S
• Lesa Kelly Klosterhoff, PT
• Mary Livesay
• Caitlin M. Marks, SLP
• Sara Paige Nighswander, MS SCHOOL PSYCHOLOGY
• River to River Community of Ullin

• Gynecology Physician in Ullin, IL
• Providers in Ullin, IL by specialty
• Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2010; 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.