Active NPI
Shane Anna Kelley, PHD
- Psychologist
- Reno, NV
National Provider Identifier
1053694372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 5421 Kietzke LN
Suite 101
Reno, NV 89511-3027 - Phone
- (775) 853-3797
- Fax
- (855) 754-6250
- NPI assigned
- Sep 22, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary | ||
| Marriage & Family Therapist | 106H00000X | 0990 | NV |
Addresses
Primary practice location
5421 Kietzke LN
Suite 101
Reno, NV 89511-3027
Mailing address
5421 Kietzke LN
Suite 101
Reno, NV 89511-3027
Phone (775) 853-3797
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 23, 2025 through Nov 23, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0990 | NV | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398643200000",
"number": "1053694372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5421 KIETZKE LN",
"address_2": "SUITE 101",
"city": "RENO",
"state": "NV",
"postal_code": "895113027",
"telephone_number": "775-853-3797",
"fax_number": "855-754-6250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5421 KIETZKE LN",
"address_2": "SUITE 101",
"city": "RENO",
"state": "NV",
"postal_code": "895113027",
"telephone_number": "775-853-3797",
"fax_number": "855-754-6250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "SHANE",
"middle_name": "ANNA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-22",
"last_updated": "2014-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "NV",
"license": "0990",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reno, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.