Individual provider Active NPI

Kelly Matchen

  • Pharmacist
  • Frankfort, IL
National Provider Identifier
1992152623
Registry record updated May 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
051288001 Issued in IL
Practice address
21164 S la Grange Rd
Frankfort, IL 60423-2010
Phone
(815) 464-5050
NPI assigned
May 23, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 051288001 IL Primary

Addresses

Primary practice location

21164 S la Grange Rd
Frankfort, IL 60423-2010

Mailing address

21164 S la Grange Rd
Frankfort, IL 60423-2010

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

LicenseStateTypeSpecialty
051288001ILMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1463961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463961600000",
    "number": "1992152623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21164 S LA GRANGE RD",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604232010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21164 S LA GRANGE RD",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604232010",
            "telephone_number": "815-464-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATCHEN",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-23",
        "last_updated": "2016-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051288001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frankfort, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2016; 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.