Healthcare Provider Details

I. General information

NPI: 1003284449
Provider Name (Legal Business Name): KELLI ECCLES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S 9TH ST
HUMBOLDT KS
66748-1908
US

IV. Provider business mailing address

PO BOX 39
HUMBOLDT KS
66748-0039
US

V. Phone/Fax

Practice location:
  • Phone: 620-473-2275
  • Fax: 620-473-2821
Mailing address:
  • Phone: 620-473-2275
  • Fax: 620-473-2821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number76903
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: