Kelly S Earnst, PH.D, HSPP

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

20041614A

Practice address

1415 Salem St
Suite 102
Lafayette, IN 47904-4100

Phone

(765) 742-1816

Fax

(765) 742-2557

NPI assigned

Oct 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Clinical Psychologist

Education

Vanderbilt University School of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• Modern Mental Health, Inc.

  • Clinical Psychologist
  • West Lafayette, IN
  • NPI 1740741750
  Medicare reassignment NPD

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656288000000",
    "number": "1104900489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 MYERS RD",
            "city": "DANVILLE",
            "state": "IN",
            "postal_code": "461229702",
            "telephone_number": "317-718-8436",
            "fax_number": "317-718-8438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 SALEM ST",
            "address_2": "SUITE 102",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479044100",
            "telephone_number": "765-742-1816",
            "fax_number": "765-742-2557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EARNST",
        "first_name": "KELLY",
        "middle_name": "S",
        "credential": "PH.D, HSPP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": "20041614A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200283610A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Max Dye, PT
• Patricia M Dymek, M.D.
• Tia Dyson
• E5 Home Care Services, LLC
• Erica Eades
• East 53Rd Street Dental-3, PC
• Katelyn Michelle Easter
• Tasha Eaton, PHARM D
• Mary C Eberle, CSW
• Brooklyn Eckart, RBT

• Clinical Neuropsychologist in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Clinical Neuropsychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.