Provider Demographics
NPI:1073707352
Name:SPILLER, KELLY N (AUD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:N
Last Name:SPILLER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-2400
Mailing Address - Country:US
Mailing Address - Phone:816-331-4327
Mailing Address - Fax:816-331-4344
Practice Address - Street 1:112 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2400
Practice Address - Country:US
Practice Address - Phone:816-331-4327
Practice Address - Fax:816-331-4344
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1998231H00000X
MO2004021609231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO42053051OtherBCBS OF KC
MO42053021OtherBCBS OF KC
MO42053031OtherBCBS OF KC
KS42053041OtherBCBS OF KC
MOMA1442005Medicare PIN
KSKA1268002Medicare PIN
MOMA1075003Medicare PIN
MOMA1443001Medicare PIN