Doctor Name: | KELLI ECCLES |
NPI Number: | 1003284449 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 76903 |
Business Practice Address: | 629 S Plummer Ave Chanute, KS - 667201928 |
Business Phone Number: | 6204314000 |
Business Fax Number: | 6204317556 |
Mailing Address: | 629 S Plummer Ave, P. O. Box 426 CHANUTE |
State: | KS |
Postal Code: | 667201928 |
Phone Number: | 6204314000 |
Fax Number: | 6204317556 |
NPI Enumeration Date: | 09/02/2015 |
NPI Last Update Date: | 09/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SE0003X |
License Number: | 76903 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | KS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Emergency |
Taxonomy Definition: |