KELLY L MAGOON (NPI# 1811303217) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811303217 |
| Entity Type | Individual |
| Full Name | KELLY L MAGOON |
| Credential | PA |
| Practice Address |
1848 Daimler Rd Rockford IL 61112-1019 |
| Practice Telephone | 8153989100 |
| Practice Fax Number | 8159866770 |
| Mailing Telephone | 8153989100 |
| Mailing Fax Number | 8159866770 |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2014-07-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1848 DAIMLER RD |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61112-1019 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790741049 | Mark Edwin Carlson | Specialist | 1848 Daimler Rd, Rockford, IL 61112-1019 | 2006-04-25 |
| 1649444548 | Regional Cardiology Consultants Ltd | Specialist | 1848 Daimler Rd, Rockford, IL 61112-1019 | 2008-04-22 |
| 1366560773 | Catherine L Blake | Nurse Practitioner | 1848 Daimler Rd, Rockford, IL 61112-1019 | 2007-03-26 |
| 1750450243 | Vanessa Ann Dal Pra Wochner | Physical Therapist | 1848 Daimler Rd, Rockford, IL 61112-1019 | 2006-11-07 |
| 1245342666 | Carlson Orthopedic Clinic Sc | Specialist | 1848 Daimler Rd, Rockford, IL 61112-1019 | 2006-08-31 |
| 1013930353 | Physician Associates Limited | Family Medicine | 1848 Daimler Rd, Rockford, IL 61112-1019 | 2006-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215213475 | Matthew Caleb Beary | Physical Therapist | 1545 Temple Lane, Rockford, IL 61112 | 2011-11-01 |
| 1730469206 | Herman Chen | Pharmacist | 2206 Barnes Blvd, Rockford, IL 61112 | 2011-08-27 |
| 1598850273 | Charles W Matty | Dentist | 1855 Daimler Rd, Rockford, IL 61112 | 2006-10-04 |
| 1942317607 | James Edward Nijoka | Dentist | 1855 Daimler Road, Rockford, IL 61112 | 2006-08-25 |
| 1053366591 | Vincent R Facchiano | Optometrist | E265 Cherryvale Mall, Rockford, IL 61112 | 2006-05-23 |
| 1780616029 | Daniel Gordon Thorstenson | Chiropractor | 1877 Daimler Rd, Rockford, IL 61112-1005 | 2006-07-07 |
| 1760800221 | Brock Stephen Field | Chiropractor | 1877 Daimler Rd, Rockford, IL 61112-1005 | 2014-04-02 |
| 1629366489 | Craig Anthony Stear Jr. | Chiropractor | 1877 Daimler Rd, Rockford, IL 61112-1005 | 2011-07-14 |
| 1104931427 | Hulsebus Rockford Chiropractic | Chiropractor | 1877 Daimler Rd, Rockford, IL 61112-1005 | 2006-08-19 |
| 1215958970 | Michael John Hulsebus | Chiropractor | 1877 Daimler Rd, Rockford, IL 61112-1005 | 2006-07-21 |
| Find all providers in zip 61112 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871063776 | Amira Al-basha | Physician Assistant | 1639 N Alpine Rd Ste 380, Rockford, IL 61107-1440 | 2018-12-04 |
| 1578042982 | Alyssa Margaret Vasylyuk | Physician Assistant | 2350 N Rockton Ave Fl 4, Rockford, IL 61103-3600 | 2018-08-08 |
| 1053778456 | Jamie Anticevich | Physician Assistant | 6595 East State Street, Rockford, IL 61108-2542 | 2016-01-15 |
| 1437534666 | Irene Dyer | Physician Assistant | 1560 Red Oak Ln, Rockford, IL 61107-2767 | 2015-07-29 |
| 1215250675 | Krista R Mohamed | Physician Assistant | 1401 E. State St., Swedish American Hospital, Rockford, IL 61104-2315 | 2010-03-12 |
| 1629121009 | Jason A. Kadar | Physician Assistant | 2902 Mcfarland Rd Ste 300, Rockford, IL 61107-6801 | 2007-01-19 |
| 1295805851 | Kristin Lynn King-shank | Physician Assistant | 171 Dogwood Dr Ne, Rockford, MI 49341-7361 | 2006-11-09 |
| 1245263268 | William John Stout | Physician Assistant | 1401 E State Street, Rockford, IL 61104 | 2006-07-10 |
| 1952356040 | Saint Anthony Medical Center | Physician Assistant | 6830 Villagreen Vw, Rockford, IL 61107-5639 | 2006-05-24 |
| 1972552131 | Andrea B Fulcomer | Physician Assistant | 2404 Charles St, Rockford, IL 61108-1602 | 2006-05-08 |
| Find all providers in ROCKFORD | ||||
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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.