Maughon, Kelley L

Maughon, Kelley L is an individual health care provider with primary practice located at 98 Medical Dr , Hannibal MO 63401-6885. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Maughon, Kelley L can be contacted via phone (573) 406-1301.

Contact Information

Primary practice address
98 Medical Dr Hannibal MO 63401-6885
Phone: (573) 406-1301
Fax: (573) 406-0511
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 6003A Kentucky
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 2002022036 Missouri

Profile Details

NPI number 1811035231
LBN Legal business name Maughon, Kelley L
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 1st, 2007
Last updated Mar 5th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811035231 NPPES
Missouri Other 175118 MO BLUE SHIELD
Missouri Other 83410 MO BLUE SHIELD
Missouri MEDICAID 917229908 MO BLUE SHIELD
Missouri MEDICAID 158119001 MO BLUE SHIELD

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