Individual provider Active NPI

Patricia Louise Kerstner, PHD

  • Clinical Psychologist
  • Flagstaff, AZ
National Provider Identifier
1104335710
Registry record updated Oct 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PHD-1329 Issued in AZ
Practice address
1338 W Forest Meadows St Ste 140
Flagstaff, AZ 86001-7226
Phone
(928) 212-8621
Fax
(928) 326-9114
NPI assigned
Sep 26, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2024

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 PHD-1329 AZ Primary

Addresses

Primary practice location

1338 W Forest Meadows St Ste 140
Flagstaff, AZ 86001-7226

Mailing address

1338 W Forest Meadows St Ste 140
Flagstaff, AZ 86001-7226
Phone (928) 212-8621

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20180207001403 AZ Practitioner - Clinical Psychologist 0244590487 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Abundant Hope Integrated Solutions LLCGroup PAC ID 8628450962, 2 clinicians

Practice addresses (Care Compare)

1338 W Forest Meadows St
Suite 140
Flagstaff, AZ 86001-7226
Phone (928) 212-8621

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PHD-1329AZMDClinical Psychologist
1329AZMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Abundant Hope Integrated Solutions, LLC CurrentSince Oct 1, 2024 Accepting new patients

Locations

1338 W Forest Meadows St
Ste 140
Flagstaff, AZ 86001
Phone (928) 212-8621

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.

NPI Registry JSON

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

{
    "created_epoch": "1506384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729209600000",
    "number": "1104335710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1338 W FOREST MEADOWS ST STE 140",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860017226",
            "telephone_number": "928-212-8621",
            "fax_number": "928-326-9114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1338 W FOREST MEADOWS ST STE 140",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860017226",
            "telephone_number": "928-212-8621",
            "fax_number": "928-326-9114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERSTNER",
        "first_name": "PATRICIA",
        "middle_name": "LOUISE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-26",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "PHD-1329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.