KELLY L MCKERAHAN D O A PROFESSIONAL MEDICAL CORPORATION (NPI# 1508110503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508110503 |
| Entity Type | Organization |
| Organization Name | KELLY L MCKERAHAN D O A PROFESSIONAL MEDICAL CORPORATION |
| Practice Address |
25095 Jefferson Ave Ste 202 Murrieta CA 92562-9107 |
| Practice Telephone | 9516969566 |
| Practice Fax Number | 9516969536 |
| Mailing Telephone | 9516969566 |
| Mailing Fax Number | 9516969536 |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2012-11-13 |
| Authorized Official Name | KELLY LEE MCKERAHAN (PHYSICIAN) |
| Authorized Official Telephone | 9516969566 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
20A6780 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PTAN | GQ212A | 01 |
| Street Address |
25095 JEFFERSON AVE STE 202 |
| City | MURRIETA |
| State | CA |
| Zip Code | 92562-9107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184705790 | Kelly Lee Mckerahan | Family Medicine | 25095 Jefferson Ave Ste 202, Murrieta, CA 92562-9107 | 2006-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831709591 | Brittney Schmidt | Behavior Technician | 25109 Hancock Avenue Suite C, Murrieta, CA 92562 | 2020-08-06 |
| 1518431410 | Heather Marie Halper | Behavioral Analyst | 25190 Handcock Ave, Suite C, Murrieta, CA 92562 | 2019-01-14 |
| 1164992798 | Tiffany L Lockhart | Counselor | 41780 Mcalby Ct, Murrieta, CA 92562 | 2018-11-27 |
| 1164992756 | Jessica Gutierrez | Specialist/Technologist | 25102 Jefferson Ave Suite D, Murrieta, CA 92562 | 2018-11-27 |
| 1972080455 | Tracy M Bronson | Nurse Practitioner | 23811 Washington Ave Ste C110, #203, Murrieta, CA 92562 | 2018-07-26 |
| 1023500279 | Brittany Marie Ramirez | Counselor | 23824 Matador Way, Murrieta, CA 92562 | 2018-06-04 |
| 1053800573 | Emily Kathryn Perrott | Physical Therapist | 24630 Washington Ave Ste 200, Murrieta, CA 92562 | 2018-05-10 |
| 1285151464 | Dexter Villanueva | Physical Therapist | 40845 Engelmann Oak St., Murrieta, CA 92562 | 2017-08-28 |
| 1407371024 | Elyaszadeh Levi Dental Corporation | Dentist | 40643 California Oaks Rd, Murrieta, CA 92562 | 2017-08-04 |
| 1023549037 | Andre Cristian De Jesus | Nurse Practitioner | 24640 Jefferson Ave Ste 208, Murrieta, CA 92562 | 2017-03-22 |
| Find all providers in zip 92562 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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|---|---|---|---|---|
| 1477960276 | Becker Pediatric Medical Corp. | Clinic/Center | 24679 Monroe Ave, Suite D102-103, Murrieta, CA 92562 | 2014-07-14 |
| 1902113186 | Jason A. Black M.d., Inc. | Clinic/Center | 40700 California Oaks Rd, Suite 207, Murrieta, CA 92562-5789 | 2010-09-09 |
| 1457442121 | Laura Williams Md | Clinic/Center | 25102 Jefferson Ave, Suite A, Murrieta, CA 92562-1707 | 2006-09-27 |
| 1992738991 | Livingwater's Medical Clinic, Inc. | Clinic/Center | 24910 Las Brisas Rd, Suite 111, Murrieta, CA 92562-4010 | 2006-07-10 |
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| 1346857802 | Sos Environmental Health | Clinic/Center | 59 Estaban Dr, Camarillo, CA 93010-1609 | 2020-09-29 |
| 1457966442 | Carlos A. Alvarez., Md., Inc | Clinic/Center | 6001 Truxtun Ave Ste 220, Bakersfield, CA 93309-0662 | 2020-09-15 |
| 1265046395 | Riverway Medical Group A Medical Corporation | Clinic/Center | 1827 S Court St Ste B, Visalia, CA 93277-5469 | 2020-09-05 |
| 1386258754 | Apollo Health Services Inc | Clinic/Center | 438 E Katella Ave Ste 229, Orange, CA 92867-4803 | 2020-09-03 |
| 1538772843 | Unlimited Urgent Care Inc. | Clinic/Center | 8781 Van Nuys Blvd Ste A, Panorama City, CA 91402-2401 | 2020-08-26 |
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| 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.