Active NPI
Krystal L Meares
- Counseling Psychologist
- Durham, NC
National Provider Identifier
1013575463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 5272
- Practice address
- 1800 Martin Luther King Jr Pkwy
Ste 104
Durham, NC 27707 - Phone
- (919) 908-8674
- NPI assigned
- May 31, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 5272 | NC | Primary |
Addresses
Primary practice location
1800 Martin Luther King Jr Pkwy
Ste 104
Durham, NC 27707
Mailing address
1800 Martin Luther King Jr Pkwy
Ste 104
Durham, NC 27707
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Etheridge Psychology, P.a. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Cary, NC
- NPI 1275820144
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634601600000",
"number": "1013575463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 MARTIN LUTHER KING JR PKWY",
"address_2": "STE 104",
"city": "DURHAM",
"state": "NC",
"postal_code": "27707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 MARTIN LUTHER KING JR PKWY",
"address_2": "STE 104",
"city": "DURHAM",
"state": "NC",
"postal_code": "27707",
"telephone_number": "919-908-8674"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEARES",
"first_name": "KRYSTAL",
"middle_name": "L",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-31",
"last_updated": "2021-10-19",
"certification_date": "2021-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "NC",
"license": "5272",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.