MEDICARE: KELLI HEDGPETH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2005026651	MO

General Provider Information

NPI Number	:	1629498563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI HEDGPETH

Provider Business Mailing Address
First Line	:	1133 SILVERLEAF LN
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-8496
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3980 SOUTH JACKSON DR
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64068
Country	:	US
Telephone Number	:	816-478-5604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2014
Last Update Date	:	04/18/2014

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Directions to “ KELLI HEDGPETH ” Practice Location

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