KELLY MIRANDA WATERS NPI 1093273542

NPI Information

NPI: 1093273542
Provider Name: KELLY MIRANDA WATERS
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
2701 17TH ST
ROCK ISLAND, IL
ZIP 61201
Phone: (309) 779-2031
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Kelly Miranda Waters is an addiction (substance use disorder) counselor in Rock Island, IL. Kelly Miranda Waters NPI is 1093273542. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2701 17TH ST
ROCK ISLAND, IL
ZIP 61201-351
Phone: (309) 779-2031

The enumeration date for this NPI number is 3/4/2019 and was last updated on 3/4/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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