Individual provider Active NPI

Kerry Catherine Bordieri

  • Clinical Psychologist
  • Hopkinsville, KY
National Provider Identifier
1073035291
Registry record updated Nov 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
173034 Issued in KY
Practice address
735 North Dr
Hopkinsville, KY 42240-2620
Phone
(270) 886-5163
Fax
(270) 886-5178
NPI assigned
Jul 10, 2017
Last updated
Nov 13, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 173034 KY Primary

Addresses

Primary practice location

735 North Dr
Hopkinsville, KY 42240-2620

Mailing address

PO Box 614
Hopkinsville, KY 42241-0614
Phone (270) 886-2205

Other names 1

  • Kerry Catherine Whiteman Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170726002239 KY Practitioner - Clinical Psychologist 9032489844 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lifeskills, IncGroup PAC ID 8820902638, 47 clinicians

Practice addresses (Care Compare)

735 N Dr
Hopkinsville, KY 42240-2620
Phone (270) 886-5163

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
173034KYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lifeskills, Inc. CurrentSince Jan 1, 2020 Accepting new patients

Locations

8324 Eagle Way
Chicago, IL 60678

608 Happy Valley Rd
Glasgow, KY 42141
Phone (270) 651-8379

735 North Dr
Hopkinsville, KY 42240
Phone (270) 886-5163

1350 US Highway 62 W
Princeton, KY 42445
Phone (270) 365-2008

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605225600000",
    "number": "1073035291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 614",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422410614",
            "telephone_number": "270-886-2205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 NORTH DR",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422402620",
            "telephone_number": "270-886-5163",
            "fax_number": "270-886-5178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDIERI",
        "first_name": "KERRY",
        "middle_name": "CATHERINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-10",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KY",
            "license": "173034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KERRY",
            "last_name": "WHITEMAN",
            "middle_name": "CATHERINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hopkinsville, KY

Sources for this page

Verify at the official NPI Registry.