Kevin Wayne Kackley, DVM

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

License

090-005298 Issued in IL

Practice address

897 850E St
Mt Sterling, IL 62353-1798

Phone

(217) 773-3366

Fax

(217) 773-4646

NPI assigned

Oct 4, 2018

Last updated

Oct 4, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1538611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538611200000",
    "number": "1891260931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 228",
            "city": "MT STERLING",
            "state": "IL",
            "postal_code": "623530228",
            "telephone_number": "217-773-3366",
            "fax_number": "217-773-4646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "897 850E ST",
            "city": "MT STERLING",
            "state": "IL",
            "postal_code": "623531798",
            "telephone_number": "217-773-3366",
            "fax_number": "217-773-4646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KACKLEY",
        "first_name": "KEVIN",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "DVM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-04",
        "last_updated": "2018-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "IL",
            "license": "090-005298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prevention Professional in Mt Sterling, IL
• Providers in Mt Sterling, IL by specialty
• Prevention Professional in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2018; 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.