Individual
KELLEY L MAUGHON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
98 MEDICAL DR, HANNIBAL, MO 63401-6885
(573) 406-1301
(573) 406-0511
Mailing address
PO BOX 511, HANNIBAL, MO 63401-0511
(573) 406-1301
(573) 406-0511
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2002022036
MO
367500000X
Certified Registered Nurse Anesthetist
6003A
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158119001
—
AR
01
—
175118
MO BLUE SHIELD
MO
01
—
83410
ARK BLUE SHIELD
AR
05
—
917229908
—
MO
Enumeration date
02/01/2007
Last updated
03/05/2014
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