Provider Demographics
NPI:1720620651
Name:ROUTT, KELLI ANN
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ANN
Last Name:ROUTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 E PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-1465
Mailing Address - Country:US
Mailing Address - Phone:605-519-9849
Mailing Address - Fax:
Practice Address - Street 1:418 E PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1465
Practice Address - Country:US
Practice Address - Phone:605-519-9849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider