KELLY BACON (NPI# 1700844313) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700844313 |
| Entity Type | Individual |
| Full Name | KELLY BACON |
| Practice Address |
1921 Stonecipher Dr Ada OK 74820-3439 |
| Practice Telephone | 5804363980 |
| Practice Fax Number | 5804216283 |
| Mailing Telephone | 5804363980 |
| Mailing Fax Number | 5804216283 |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2015-01-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367H00000X | Anesthesiologist Assistant | R0071221 | OK | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1921 STONECIPHER DR |
| City | ADA |
| State | OK |
| Zip Code | 74820-3439 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528050291 | Carol Lynn Rhoads | Nurse Anesthetist, Certified Registered | 1921 Stonecipher Dr, Chickasaw Nation Health System, Ada, OK 74820-3439 | 2005-08-18 |
| 1295336683 | Tina S Johnston | Nurse Anesthetist, Certified Registered | 1921 Stonecipher Dr, Ada, OK 74820-3439 | 2020-11-03 |
| 1972125706 | Ana Nguyen Phan | Student in an Organized Health Care Education/Training Program | 1921 Stonecipher Dr, Ada, OK 74820-3439 | 2020-05-14 |
| 1932720349 | Tony Glen Wallen | Student in an Organized Health Care Education/Training Program | 1921 Stonecipher Dr, Ada, OK 74820-3439 | 2020-04-27 |
| 1053931840 | Eric Vincent Harris | Student in an Organized Health Care Education/Training Program | 1921 Stonecipher Dr, Ada, OK 74820-3439 | 2020-04-21 |
| 1417581109 | Amy Stepp | Licensed Practical Nurse | 1921 Stonecipher Dr, Ada, OK 74820-3439 | 2020-03-03 |
| 1477185445 | Kimberly D Wilson | Licensed Practical Nurse | 1921 Stonecipher Dr, Ada, OK 74820-3439 | 2020-02-07 |
| 1275174435 | Abby Lynn Crow | Audiologist | 1921 Stonecipher Dr, Ada, OK 74820-3439 | 2019-09-30 |
| 1821648809 | Mercedes Milligan | Counselor | 1921 Stonecipher Dr, Ada, OK 74820-3439 | 2019-09-12 |
| 1447808852 | Shandi Lynn Martin | Counselor | 1921 Stonecipher Dr, Ada, OK 74820-3439 | 2019-08-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578103727 | Curry Orthopedics and Sports Medicine Pllc | Orthopaedic Surgery | 919 Colony Drive, Ada, OK 74820 | 2020-01-15 |
| 1215574603 | Miranda Denise Bowman | Counselor | 1300 Hoppe Blvd., Suite 5, Ada, OK 74820 | 2019-12-04 |
| 1326509654 | Patricia June Harjo | Case Manager/Care Coordinator | Nittak Himitta' Women's and Children's Recovery Center, 2024 Te Ata Drive, Ada, OK 74820 | 2019-03-28 |
| 1649737172 | Rylee Nikole Leblanc | Case Manager/Care Coordinator | 1119 S High School St, Ada, OK 74820 | 2019-02-20 |
| 1891251328 | David Kinback | Rehabilitation Counselor | 1400 Hoppe Blvd., Suite 3, Cn Recovery Resource Services, Ada, OK 74820 | 2019-02-20 |
| 1922571009 | Central Oklahoma Family Medical Center, Inc. | Pharmacy | 905 Colony Dr, Ada, OK 74820 | 2019-01-10 |
| 1063988673 | Central Oklahoma Family Medical Center, Inc | Clinic/Center | 905 Colony Drive Bldg, Ada, OK 74820 | 2018-10-22 |
| 1265907885 | Apex Surgery Center, LLC | Surgery | 2001 Cradduck Road, Ada, OK 74820 | 2018-10-10 |
| 1689150898 | Sabrina Simmons | Social Worker | 2516 Oakhurst Dr Apt E, Ada, OK 74820 | 2018-07-11 |
| 1700370467 | Brianna Leigh Youngwolfe | Nurse Practitioner | 2020 Arlington St Ste 6, Ada, OK 74820 | 2018-06-17 |
| Find all providers in zip 74820 | ||||
| Taxonomy Code | 367H00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Anesthesiologist Assistant |
| An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a two-year anesthesiology assistant program, which is focused upon the delivery and maintenance of anesthesia care as well as advanced patient monitoring techniques. An Anesthesiologist Assistant must work as a member of the anesthesia care team under the direction of a qualified Anesthesiologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467400069 | Jerry Gregory | Anesthesiologist Assistant | 1921 Stonecipher Blvd, Ada, OK 74820 | 2006-05-05 |
| 1184682783 | Mary Hampton | Anesthesiologist Assistant | 1001 N Country Club Rd, Ada, OK 74820-2847 | 2006-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902429707 | Alex D Dumontier | Anesthesiologist Assistant | 3300 Nw Expressway, Oklahoma City, OK 73112-4418 | 2020-05-27 |
| 1558983387 | Anna S Kim | Anesthesiologist Assistant | 3300 Nw Expwy, Oklahoma City, OK 73112-4418 | 2020-05-14 |
| 1073134144 | Parker Thomas Richardson | Anesthesiologist Assistant | 3300 Nw Expwy, Oklahoma City, OK 73112-4418 | 2020-04-30 |
| 1225657711 | Tyra M Jenkins | Anesthesiologist Assistant | 3300 Nw Expressway, Oklahoma City, OK 73112-4418 | 2020-04-14 |
| 1528694148 | Savannah Schae Scott | Anesthesiologist Assistant | 3300 Nw Expressway, Oklahoma City, OK 73112-4418 | 2020-03-15 |
| 1306481239 | Kleopatra Ruddock | Anesthesiologist Assistant | 3300 Nw Expressway, Oklahoma City, OK 73112-4418 | 2019-11-14 |
| 1356983977 | Jason Robert Brogan | Anesthesiologist Assistant | 3300 Nw Expressway, Oklahoma City, OK 73112-4418 | 2019-10-15 |
| 1497307144 | Cody Ryan Gaul | Anesthesiologist Assistant | 5030 N May Ave, Oklahoma City, OK 73112-6010 | 2019-07-12 |
| 1699232736 | Jordan Michael Holt | Anesthesiologist Assistant | 3300 Nw Expressway, Oklahoma City, OK 73112-4418 | 2019-02-25 |
| 1881159085 | Small Group Anesthesia Services, LLC | Anesthesiologist Assistant | 4716 W Urbana St, Broken Arrow, OK 74012-5997 | 2019-02-01 |
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| 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.