Provider Demographics
NPI:1851502421
Name:HAND, KELLY K (PA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:K
Last Name:HAND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1268
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-1268
Mailing Address - Country:US
Mailing Address - Phone:618-457-4900
Mailing Address - Fax:618-457-4600
Practice Address - Street 1:665 E LAKE RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5347
Practice Address - Country:US
Practice Address - Phone:618-457-4900
Practice Address - Fax:618-457-4600
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085378OtherHEALTH ALLIANCE NUMBER
IL207151Medicare ID - Type UnspecifiedMEDICARE NUMBER
ILP99748Medicare UPIN