Provider Demographics
NPI:1003284449
Name:ECCLES, KELLI (APRN)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:ECCLES
Suffix:
Gender:F
Credentials:APRN
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 39
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:KS
Mailing Address - Zip Code:66748-0039
Mailing Address - Country:US
Mailing Address - Phone:620-473-2275
Mailing Address - Fax:620-473-2821
Practice Address - Street 1:202 S 9TH ST
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:KS
Practice Address - Zip Code:66748-1908
Practice Address - Country:US
Practice Address - Phone:620-473-2275
Practice Address - Fax:620-473-2821
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76903363LF0000X, 364SF0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS76903OtherSTATE LICENSE