NPI Registry.org

Kelly R. Minihane

NPI Registration Record

Provider / OrganizationNPIDate Certified
KELLY R. MINIHANE14876222052021-11-21

Kelly R. Minihane is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1487622205. Registration indicates Kelly R. Minihane is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers) Access to Adult/Geriatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant: Medical, ) (All Other Specialties & Provider Types, ) (Physician Assistant Medical, Physician Assistants & Advanced Practice Nursing Providers) (Physician Assistant, ) Access to Adult/Geriatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers)

RegistrationPART-B:Y
DME:Y
HHA:Y
PMD:Y
Entity TypeIndividual
Provider NameMs. Kelly R. Minihane PA-C
Other Provider Name Kelly R. Mcmahan
Practice Office Address1404 WASHINGTON STREET
MENDOTA, IL US
Practice Office Telephone8155381825
Practice Office Fax7195245357
Mailing Address1404 WASHINGTON STREET
MENDOTA, IL 61342 US
Business Telephone8155381825
Business Fax7195267984
HPT Codes
CodePractice
License No
State
363A00000XAccess to Adult/Geriatric Primary Care Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician AssistantAccess to Pediatric Primary Care Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers
Physician Assistant
All Other Specialties & Provider Types

Physician Assistant
Physician Assistants & Advanced Practice Nursing Providers
2078
CO
363AM0700XAccess to Adult/Geriatric Primary Care Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician AssistantAccess to Pediatric Primary Care Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Physician Assistant: Medical

All Other Specialties & Provider Types

Physician Assistant Medical
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistant
2078
CO
363A00000X PRIMARYAccess to Adult/Geriatric Primary Care Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician AssistantAccess to Pediatric Primary Care Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers
Physician Assistant
All Other Specialties & Provider Types

Physician Assistant
Physician Assistants & Advanced Practice Nursing Providers
085-003885
IL
OPI Codes
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