KELLY R WILEY (NPI# 1144530544) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144530544 |
| Entity Type | Individual |
| Full Name | KELLY R WILEY |
| Credential | BS MLS (ASCP) |
| Practice Address |
3200 Canyon Lake Dr Rapid City SD 57702-8114 |
| Practice Telephone | 6053552229 |
| Practice Fax Number | 6053552514 |
| Mailing Telephone | 6053552229 |
| Mailing Fax Number | 6053552514 |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2010-10-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 246QM0706X |
Spec/Tech, Pathology Specialization: Medical Technologist |
25324986 | Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SD | 0140070 | 05 | |
| SD | MEDICAID | 5549050 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871820506 | Kelly Marie Wiley | Speech-Language Pathologist | 110 Hillside Dr, Forney, TX 75126-9702 | 2009-11-18 |
| 1043580459 | Kelly Lynn Wiley | Counselor | 5929 N May Ave, Ste 302 Box 37, Oklahoma City, OK 73112-3909 | 2012-01-03 |
| 1912113184 | Kelly Ponder Wiley | Marriage & Family Therapist | 895 State Farm Rd, Suite 103, Boone, NC 28607-4917 | 2007-05-15 |
| Street Address |
3200 CANYON LAKE DR |
| City | RAPID CITY |
| State | SD |
| Zip Code | 57702-8114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578566014 | Linnea Ann Putnam | Pharmacist | 3200 Canyon Lake Dr, Rapid City, SD 57702-8114 | 2005-05-28 |
| 1588201404 | Rachel Paulsen | Nurse Practitioner | 3200 Canyon Lake Dr, Rapid City, SD 57702-8114 | 2019-12-10 |
| 1376105452 | Great Plains Tribal Chairmen's Health Board | Pharmacy | 3200 Canyon Lake Dr, Rapid City, SD 57702-8114 | 2019-06-28 |
| 1639641350 | Cindy C Jacobs | Spec/Tech, Pathology | 3200 Canyon Lake Dr, Rapid City, SD 57702-8114 | 2018-12-19 |
| 1205344660 | Ethan A Harris | Pharmacist | 3200 Canyon Lake Dr, Rapid City, SD 57702-8114 | 2018-01-18 |
| 1770094674 | Eric C Robinson | Pharmacist | 3200 Canyon Lake Dr, Rapid City, SD 57702-8114 | 2017-10-18 |
| 1588173322 | Alan Ross Patterson | Pharmacist | 3200 Canyon Lake Dr, Rapid City, SD 57702-8114 | 2017-09-25 |
| 1710407911 | Danielle Prudich | Registered Nurse | 3200 Canyon Lake Dr, Rapid City, SD 57702-8114 | 2017-06-20 |
| 1730609868 | Jane Phillips | Dental Hygienist | 3200 Canyon Lake Dr, Rapid City, SD 57702-8114 | 2017-06-20 |
| 1407382666 | Dawn Badwound | Registered Nurse | 3200 Canyon Lake Dr, Rapid City, SD 57702-8114 | 2017-05-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366049660 | Byrne Dental, Professional LLC | Dentist | 3825 Canyon Lake Dr, Rapid City, SD 57702 | 2020-10-08 |
| 1427603026 | Mikaela Licht | Technician | 4310 Cedar Ridge Pl. Apt #5, Rapid City, SD 57702 | 2019-08-09 |
| 1932761335 | Great Plains Tribal Chairmen's Health Board | Pharmacy | Oyate Health Center, 3200 Canyon Lake Drive, Rapid City, SD 57702 | 2019-07-05 |
| 1598231334 | Regional Health Physicians, Inc. | Clinic/Center | 1635 Caregiver Circle, Rapid City, SD 57702 | 2018-10-19 |
| 1851813224 | Angie Deneire | Licensed Practical Nurse | 7312 Pinon Jay Circle, Rapid City, SD 57702 | 2017-07-07 |
| 1073063830 | Kirsten William-kennedy Dds, Ms, P.C. | Dentist | 740 Sheridan Lk. Rd. Suite A, Rapid City, SD 57702 | 2016-10-05 |
| 1932558939 | Emily T Rausch | Physical Therapist | 2040 West Main, #212, Rapid City, SD 57702 | 2016-06-09 |
| 1033597810 | John Dennis Burke | Speech-Language Pathologist | 4635 Wentworth Drive, Rapid City, SD 57702 | 2015-05-12 |
| 1013394535 | Dakota Regional Periodontics | Dentist | 2800 Jackson Blvd #6, Rapid City, SD 57702 | 2015-05-05 |
| 1306272414 | Lindsy Jo Wathen | Speech-Language Pathologist | 13232 Klondike Road, Rapid City, SD 57702 | 2013-09-20 |
| Find all providers in zip 57702 | ||||
| Taxonomy Code | 246QM0706X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Spec/Tech, Pathology |
| Specialization | Medical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477738532 | Gerald Jerome Hotz | Spec/Tech, Pathology | 6080 Coady Ct, Rapid City, SD 57703-9603 | 2008-01-07 |
| 1639641350 | Cindy C Jacobs | Spec/Tech, Pathology | 3200 Canyon Lake Dr, Rapid City, SD 57702-8114 | 2018-12-19 |
| 1689996068 | Joseph Edward Ferber | Spec/Tech, Pathology | 3200 Canyon Lake Dr, Rapid City, SD 57702-8114 | 2010-02-25 |
| 1255663670 | Kelly Joe Thomas | Spec/Tech, Pathology | 3200 Canyon Lake Dr, Rapid City, SD 57702-8114 | 2010-02-10 |
| 1679805162 | Sarah Ann Lantis | Spec/Tech, Pathology | 3200 Canyon Lake Dr, Rapid City, SD 57702-8114 | 2010-02-08 |
| 1073845566 | Jeanette Kay Ofstad | Spec/Tech, Pathology | 3200 Canyon Lake Dr, Rapid City, SD 57702-8114 | 2010-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063711471 | Elizabeth Susan Erickson | Spec/Tech, Pathology | 2400 Fox Rd, Sturgis, SD 57785-2204 | 2011-03-24 |
| 1083933436 | David-rush Douglas Lowe | Spec/Tech, Pathology | 506 6th Ave W, Mobridge, SD 57601-2048 | 2010-05-25 |
| 1497070080 | James Brian Moeller | Spec/Tech, Pathology | 100 Lake Traverse Drive, Sisseton, SD 57262 | 2010-04-07 |
| 1679735989 | Donavon Clay Lawrence | Spec/Tech, Pathology | 100 Lake Traverse Dr, Sisseton, SD 57262-7046 | 2008-06-27 |
| 1073775557 | Brian E Labelle | Spec/Tech, Pathology | 100 Lake Traverse Dr, Sisseton, SD 57262-7046 | 2008-06-26 |
| 1346413762 | Leslie Rae Kerwin | Spec/Tech, Pathology | 211 S River St, Chamberlain, SD 57325-1525 | 2008-04-07 |
| 1740497775 | Wanda Jean Dally | Spec/Tech, Pathology | 111 Washington Ave Nw, Wagner, SD 57380 | 2007-05-17 |
| City | RAPID CITY |
| Zip Code | 57702 |
Please comment or provide details below to improve the information on KELLY R WILEY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.