Provider Demographics
NPI:1417912643
Name:YOXALL, KELLY E (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:E
Last Name:YOXALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:KS
Mailing Address - Zip Code:67467-1608
Mailing Address - Country:US
Mailing Address - Phone:785-392-2144
Mailing Address - Fax:785-392-3231
Practice Address - Street 1:830 ELM ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:KS
Practice Address - Zip Code:67467-1608
Practice Address - Country:US
Practice Address - Phone:785-392-2144
Practice Address - Fax:785-392-3231
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100395200DMedicaid
KS110116064Medicare PIN
KSF52901Medicare UPIN