JODY L KELLY (NPI# 1932107208) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932107208 |
| Entity Type | Individual |
| Full Name | JODY L KELLY |
| Credential | M.D. |
| Practice Address |
2901 N. Knoxville Ave. Peoria IL 61603 |
| Practice Telephone | 3096887010 |
| Practice Fax Number | 3096887044 |
| Mailing Telephone | 3096887010 |
| Mailing Fax Number | 3096887044 |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2011-12-07 |
| NPI Deactivation Date | 03/16/2006 |
| NPI Reactivation Date | 2006-03-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 036102228 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036102228 | 05 |
| Street Address |
2901 N. KNOXVILLE AVE. |
| City | PEORIA |
| State | IL |
| Zip Code | 61603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578870846 | Vasantha L. Anne | Obstetrics & Gynecology | 2901 N. Knoxville Ave., Peoria, IL 61603 | 2010-09-08 |
| 1710138508 | Alison B Eeten | Nurse Practitioner | 2901 N. Knoxville Ave., Peoria, IL 61603 | 2008-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598362980 | Courtney Klein | Nurse Practitioner | 1306 N. Berkley Ave, Peoria, IL 61603 | 2020-10-08 |
| 1114588217 | Kong Xing Wang | Dentist | 320 East Armstrong Ave, Peoria, IL 61603 | 2019-06-28 |
| 1073015319 | Sara Kristine Rosenbery | Nurse Practitioner | 515 Ne Glen Oak Ave Ste 202, Peoria, IL 61603 | 2018-03-02 |
| 1861860058 | Jennifer Michelle Kelsey | Clinical Nurse Specialist | 420 Ne Glen Oak Avenue, Suite 401, Peoria, IL 61603 | 2015-09-04 |
| 1467859793 | Bonnie Lansing | Counselor | 617 N Gendale Avenue, Behavioral Health Adult Program, Peoria, IL 61603 | 2014-12-02 |
| 1639597172 | Jael K. Mahasi | Counselor | 1800 Ne Perry Avenue, Peoria, IL 61603 | 2014-04-02 |
| 1992054829 | Justin S Ferragut | Radiology | 530 Northeast Glen Oak Avenue, Peoria, IL 61603 | 2012-09-06 |
| 1780952994 | Syed Muhammad Tayyab | Internal Medicine | 828 Ne Glen Oak Ave Apt No208a, Peoria, IL 61603 | 2011-12-02 |
| 1528389079 | St. Francis Medical Center | General Acute Care Hospital | 530 N E Glen Oak Ave, Peoria, IL 61603 | 2010-06-18 |
| 1780810648 | Children's Home Association of Illinois | Voluntary or Charitable | 400 E. Frye, Peoria, IL 61603 | 2009-06-05 |
| Find all providers in zip 61603 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083097000 | Pilar Mckay Rainey | Obstetrics & Gynecology | 530 Ne Glen Oak, Peoria, IL 61634-0001 | 2015-07-08 |
| 1881084838 | Pinnacle Women's Center LLC | Obstetrics & Gynecology | 15396 N 83rd Ave Ste F100, Peoria, AZ 85381 | 2015-01-29 |
| 1124468129 | Kaleb L. Jacobs | Obstetrics & Gynecology | 6708 N. Knoxville Ave, Suite 1, Peoria, IL 61614 | 2013-07-05 |
| 1093062077 | Rejuv David Kindred, PC | Obstetrics & Gynecology | 2806 N Knoxville Ave, Peoria, IL 61604-2870 | 2012-08-09 |
| 1528368875 | Couri Center for Gynecology and Integrative Womens Health Sc | Obstetrics & Gynecology | 6708 North Knoxville Ave, Suite 1, Peoria, IL 61614 | 2010-11-02 |
| 1376787523 | Vanessa Marie Cameron | Obstetrics & Gynecology | 8600 N Sate Route 91, Suite 330, Peoria, IL 61615 | 2009-04-30 |
| 1437311651 | Marquia T Redden-grier | Obstetrics & Gynecology | 21755 N 77th Ave, Suite E-1200, Peoria, AZ 85382-2111 | 2008-06-29 |
| 1023298916 | Edward C Luan Md Sc | Obstetrics & Gynecology | 7620 N University St Ste 108, Peoria, IL 61614-8300 | 2007-11-07 |
| 1881893212 | Xochitl Lorena Garcia | Obstetrics & Gynecology | 2901 N. Knoxville Ave, Peoria, IL 61603-1747 | 2007-07-16 |
| 1881810224 | Ali Azadi | Obstetrics & Gynecology | Star Clinic/star Urogynecology, 14155 N 83rd Ave, Bld 6, Suite 138, Peoria, AZ 85381 | 2007-04-17 |
| Find all providers in PEORIA | ||||
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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.