| Doctor Name: | MS. KELLY R. MINIHANE |
| NPI Number: | 1487622205 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 2078 |
| Business Practice Address: | 1404 Washington Street Mendota, IL - 61342 |
| Business Phone Number: | 8155381825 |
| Business Fax Number: | 7195245357 |
| Mailing Address: | 1404 Washington Street, MENDOTA |
| State: | IL |
| Postal Code: | 61342 |
| Phone Number: | 8155381825 |
| Fax Number: | 7195267984 |
| NPI Enumeration Date: | 03/08/2006 |
| NPI Last Update Date: | 12/01/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 2078 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |