Active NPI
Kellie Victoria Walker Ishmael, PSY.D.
- Psychologist
- Ardsley, NY
National Provider Identifier
1164660197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 012185
- Practice address
- 410 Saw Mill River Rd
Ardsley Park
Ardsley, NY 10502-2614 - Phone
- (914) 479-0036
- Fax
- (914) 479-0037
- NPI assigned
- Jan 29, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 012185 | NY | Primary |
Addresses
Primary practice location
410 Saw Mill River Rd
Ardsley Park
Ardsley, NY 10502-2614
Mailing address
17 Fuller Rd
Ossining, NY 10562-5607
Phone (914) 762-3826
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012185 | NY | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paxxon Healthcare Services | Past | Accepting new patients |
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.
-
- Early Intervention Provider Agency
- Ardsley, NY
- NPI 1780821587
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233187200000",
"number": "1164660197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 FULLER RD",
"city": "OSSINING",
"state": "NY",
"postal_code": "105625607",
"telephone_number": "914-762-3826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 SAW MILL RIVER RD",
"address_2": "ARDSLEY PARK",
"city": "ARDSLEY",
"state": "NY",
"postal_code": "105022614",
"telephone_number": "914-479-0036",
"fax_number": "914-479-0037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALKER ISHMAEL",
"first_name": "KELLIE",
"middle_name": "VICTORIA",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-01-29",
"last_updated": "2009-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "012185",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ardsley, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.