Kelly L Dustin (NPI# 1114957362, PAC ID# 2264583459) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1114957362 |
| PAC ID by PECOS | 2264583459 |
| Professional Enrollment ID | I20090629000517 |
| Full Name | Kelly L Dustin |
| Organization Legal Name | FALL RIVER MEDICAL PLLC |
| Address |
21 Winn Dr Rexburg ID 83440-5277 |
| Phone Number | 2088815222 |
| Gender | M |
| Medical School | KIRKSVILLE COLLEGE OF OSTEOPATHIC MEDICINE |
| Graduation Year | 2006 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 4981846698 |
| Number of Group Practice Members | 6 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 130025 | MADISON MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 21 Winn Dr, Rexburg, ID 83440-5277 | 2088815222 | FALL RIVER MEDICAL PLLC |
| Organization Legal Name | FALL RIVER MEDICAL PLLC |
| Physicians | 6 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jeremy Chad Rindlisbacher | Physician Assistant | Fall River Medical Pllc | 21 Winn Dr, Rexburg, ID 83440-5277 |
| Austin C Gillette | Family Medicine | Fall River Medical Pllc | 21 Winn Dr, Rexburg, ID 83440-5277 |
| Steven Craig Pierce | Physician Assistant | Fall River Medical Pllc | 21 Winn Dr, Rexburg, ID 83440-5277 |
| Terry J Anderson | Physician Assistant | Fall River Medical Pllc | 21 Winn Dr, Rexburg, ID 83440-5277 |
| Brennen S Larsen | Physician Assistant | Fall River Medical Pllc | 21 Winn Dr, Rexburg, ID 83440-5277 |
| Street Address |
21 WINN DR |
| City | REXBURG |
| State | ID |
| Zip | 83440-5277 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jeremy Chad Rindlisbacher | Physician Assistant | Fall River Medical Pllc | 21 Winn Dr, Rexburg, ID 83440-5277 |
| Austin C Gillette | Family Medicine | Fall River Medical Pllc | 21 Winn Dr, Rexburg, ID 83440-5277 |
| Steven Craig Pierce | Physician Assistant | Fall River Medical Pllc | 21 Winn Dr, Rexburg, ID 83440-5277 |
| Terry J Anderson | Physician Assistant | Fall River Medical Pllc | 21 Winn Dr, Rexburg, ID 83440-5277 |
| Brennen S Larsen | Physician Assistant | Fall River Medical Pllc | 21 Winn Dr, Rexburg, ID 83440-5277 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Craig Benjamin Ashby | Chiropractic | 16 S 1st, Rexburg, ID 83440-0303 | |
| Adriann J Wilcox | Nurse Practitioner | Madison Co Memorial Hospital | 393 E 2nd, Rexburg, ID 83440-1605 |
| Corey T Rammell | Family Medicine | Madison Co Memorial Hospital | 393 E 2nd, Rexburg, ID 83440-1605 |
| Joseph E Watson | Family Medicine | Madison Co Memorial Hospital | 393 E 2nd, Rexburg, ID 83440-1605 |
| Matheau G Eysser | Orthopedic Surgery | Madison Co Memorial Hospital | 393 E 2nd, Rexburg, ID 83440-1605 |
| Zachery M Brunson | Physician Assistant | Madison Co Memorial Hospital | 393 E 2nd, Rexburg, ID 83440-1605 |
| Charles J Zollinger | Family Medicine | Madison Co Memorial Hospital | 393 E 2nd, Rexburg, ID 83440-1605 |
| Rex Meredith | Physician Assistant | Madison Co Memorial Hospital | 393 E 2nd, Rexburg, ID 83440-1605 |
| Wade D Gordon | Clinical Social Worker | 310 N 2nd E, 112 South Fork Services, Rexburg, ID 83440-1606 | |
| Jody B Rawlings | Physical Therapy | 217 N 2nd, Rexburg, ID 83440-1621 | |
| Find all physicians in zip 83440 | |||
| City | REXBURG |
| Zip Code | 83440 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | REXBURG + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Kelly L Dustin.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.