Individual
CHERI W KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7 S HOSPITAL DR, MURPHYSBORO, IL 62966-3333
(618) 687-3418
Mailing address
PO BOX 577, CARTERVILLE, IL 62918-0577
(618) 956-9540
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085001319
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085001319
STATE LICENSE NUMBER
IL
01
—
132564
HEALTH ALLIANCE
IL
05
—
370966854002
—
IL
05
—
370966854005
—
IL
01
—
CF3444
MEDICARE RR
IL
Enumeration date
01/05/2007
Last updated
09/13/2012
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