KELLY MIRANDA WATERS (NPI# 1093273542) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093273542 |
| Entity Type | Individual |
| Full Name | KELLY MIRANDA WATERS |
| Practice Address |
2701 17th St Rock Island IL 61201-5351 |
| Practice Telephone | 3097792031 |
| Mailing Telephone | 3097792031 |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2019-03-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841502366 | Kelly J Waters | Social Worker | 1503 Santa Rosa Rd, Suite 211, Richmond, VA 23229-5105 | 2010-07-13 |
| 1821232455 | Kelly Anne Waters | Internal Medicine | 4100 Lake Dr Se Ste 200, Grand Rapids, MI 49546-8292 | 2009-04-27 |
| Street Address |
2701 17TH ST |
| City | ROCK ISLAND |
| State | IL |
| Zip Code | 61201-5351 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336142629 | Deepak Ahuja | Internal Medicine | 2701 17th St, Rock Island, IL 61201-5351 | 2005-05-31 |
| 1205436052 | Penny Ann Liebbe | Psychiatry & Neurology | 2701 17th St, Rock Island, IL 61201-5351 | 2020-10-30 |
| 1740880863 | Ginger I Busby | Counselor | 2701 17th St, Rock Island, IL 61201-5351 | 2020-10-28 |
| 1366041022 | Elizabeth Erin Montgomery | Registered Nurse | 2701 17th St, Rock Island, IL 61201-5351 | 2020-10-22 |
| 1285232587 | Jillian Elizabeth Spragg | Counselor | 2701 17th St, Rock Island, IL 61201-5393 | 2020-10-09 |
| 1902403140 | Kelsey Jean Mickelson | Counselor | 2701 17th St, Rock Island, IL 61201-5351 | 2020-10-01 |
| 1033725452 | Amber Michelle Winters | Counselor | 2701 17th St, Rock Island, IL 61201-5351 | 2020-09-21 |
| 1295341865 | Kaitlyn Dawn Shannon | Counselor | 2701 17th St, Rock Island, IL 61201-5351 | 2020-09-19 |
| 1902412539 | Alex Strupp | Counselor | 2701 17th St, Rock Island, IL 61201-5351 | 2020-09-18 |
| 1861008641 | Leanne Elizabeth Zazzetti | Counselor | 2701 17th St, Rock Island, IL 61201-5351 | 2020-09-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689206245 | Judy Kay Moore | Technician | 2439 8th Ave, Rock Island, IL 61201 | 2020-02-11 |
| 1053956862 | Christina Beam | Counselor | 1413 40th Street, Rock Island, IL 61201 | 2019-11-15 |
| 1356843817 | Stephanie Kaye Jones | Counselor | 2701 17th St., Rock Island, IL 61201 | 2018-03-01 |
| 1073062030 | Innovative Transport Enterprise, LLC | Non-emergency Medical Transport (VAN) | 2239 24th Street Apt 15c, Rock Island, IL 61201 | 2016-09-30 |
| 1124575733 | Robert Young Center | Community Based Residential Treatment Facility, Mental Illness | 2701 - 17 Street, Rockisland, IL 61201 | 2016-09-01 |
| 1538520903 | James Keith Frainey | Psychologist | 805 19th Street, Transitions Mhs, Rock Island, IL 61201 | 2016-03-14 |
| 1417340837 | Brandon Lee Sachwitz | Physician Assistant | 2701 17th Street, Trinity Medical Center, Rock Island, IL 61201 | 2015-03-10 |
| 1215366679 | Kimberly Lyall | Physical Therapy Assistant | 767 30th Street, Rock Island, IL 61201 | 2013-11-06 |
| 1386080745 | The Abbey Center, LLC | Clinic/Center | 3031 5th Ave., Rock Island, IL 61201 | 2013-05-13 |
| 1487097382 | Joe Lee Westerhof | Veterinarian | 2529 11th St, Rock Island, IL 61201 | 2013-04-10 |
| Find all providers in zip 61201 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164930772 | Josh Mark Hirst | Counselor | 4230 11th St, Rock Island, IL 61201-6746 | 2018-01-17 |
| 1033549720 | Rita Sterling | Counselor | 211 19th St, Department of Veterans Affairs, Ste. M2, Rock Island, IL 61201-8028 | 2013-11-18 |
| 1841536794 | John Michael Walsh | Counselor | 2052 3rd Ave, Rock Island, IL 61201-8803 | 2012-12-21 |
| 1053496695 | Consuela Nmn Rogers | Counselor | 1 Rock Island Usahc Blg 110, Basement Rm 36, Rock Island, IL 61299-7324 | 2006-10-25 |
| 1861008641 | Leanne Elizabeth Zazzetti | Counselor | 2701 17th St, Rock Island, IL 61201-5351 | 2020-09-17 |
| 1770114522 | Marissa Jean Rutenbeck | Counselor | 2701 17th St, Rock Island, IL 61201-5351 | 2020-01-30 |
| 1053963868 | Keri Lynn Fager | Counselor | 2701 17th St, Rock Island, IL 61201-5351 | 2019-07-11 |
| 1356900922 | Ariel Lynn Rodriguez | Counselor | 4230 11th St, Rock Island, IL 61201-6746 | 2019-06-07 |
| 1124500566 | Jason R Rockwell | Counselor | 2701 17th Street, Rock Island, IL 61201 | 2018-09-01 |
| 1174019749 | Debbie Ann Swafford | Counselor | 2701 17th St, Rock Island, IL 61201 | 2018-07-07 |
| Find all providers in ROCK ISLAND | ||||
| City | ROCK ISLAND |
| Zip Code | 61201 |
Please comment or provide details below to improve the information on KELLY MIRANDA WATERS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.