Kellogg, Mark T

Kellogg, Mark T is an sole proprietor health care provider with primary practice located at 1101 Holly Ct , Farmington MO 63640-1171. He recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Ambulatory Surgical, Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered. Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered is his primary health care specialty. Kellogg, Mark T can be contacted via phone (573) 631-5116.

Contact Information

Primary practice address
1101 Holly Ct Farmington MO 63640-1171
Phone: (573) 631-5116
Fax: (573) 756-8288
Website:
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Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Ambulatory Surgical 261QA1903X 154494 Missouri
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 154494 Missouri

Profile Details

NPI number 1326103490
LBN Legal business name Kellogg, Mark T
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 27th, 2006
Last updated Feb 11th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326103490 NPPES
Missouri MEDICAID 914703533

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