Amanda Kelley, AAS

Key facts

NPI

1124274592

Entity type

Individual (NPI type 1)

Primary specialty

Developmental Therapist 222Q00000X

Practice address

48 Meadowview CT
Campbellsville, KY 42718-1100

Phone

(270) 465-1072

NPI assigned

Aug 17, 2008

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Associate of Applied Science

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 31, 2016.

{
    "created_epoch": "1218931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464652800000",
    "number": "1124274592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 MEADOWVIEW CT",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427181030",
            "telephone_number": "270-465-1072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 MEADOWVIEW CT",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427181100",
            "telephone_number": "270-465-1072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "AMANDA",
        "credential": "AAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-17",
        "last_updated": "2016-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST STEPS",
            "identifier": "1453",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Campbellsville, KY · Developmental Therapist in Kentucky