Active NPI
Kelley N Squires, MD
- Pediatrics Physician
- Columbia, MO
National Provider Identifier
1871279661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 2023023785
- Practice address
- 1 Hospital Drive Dco58.00
Columbia, MO 65212 - Phone
- (573) 882-4438
- NPI assigned
- Jun 26, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 2023023785 | MO | Primary |
Addresses
Primary practice location
1 Hospital Drive Dco58.00
Columbia, MO 65212
Mailing address
PO Box 7411626
Chicago, IL 60674-5626
Other practice location 1
1000 E Primrose St Ste 300
Springfield, MO 65807-5178
Phone (000) 000-0000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230720002631 | MO | Order and Referring Only - Pediatric Medicine | 2860852928 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2023023785 | MO | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786320000000",
"number": "1871279661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7411626",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606745626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 HOSPITAL DRIVE DCO58.00",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "65212",
"telephone_number": "573-882-4438"
}
],
"practiceLocations": [
{
"address_1": "1000 E Primrose St Ste 300",
"address_purpose": "LOCATION",
"city": "Springfield",
"state": "MO",
"postal_code": "658075178",
"country_code": "US",
"telephone_number": "000-000-0000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SQUIRES",
"first_name": "KELLEY",
"middle_name": "N",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-06-26",
"last_updated": "2026-08-10",
"certification_date": "2026-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "2023023785",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.