Provider Demographics
NPI:1811303217
Name:MAGOON, KELLY L (PA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:MAGOON
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1848 DAIMLER RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61112-1019
Mailing Address - Country:US
Mailing Address - Phone:815-398-9100
Mailing Address - Fax:815-986-6770
Practice Address - Street 1:1848 DAIMLER RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61112-1019
Practice Address - Country:US
Practice Address - Phone:815-398-9100
Practice Address - Fax:815-986-6770
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant