David B Kelley, PHD

Key facts

NPI

1174565121

Entity type

Individual (NPI type 1)

Primary specialty

Psychologist 103T00000X

License

31422 (TX)

Practice address

1010 Fir LN
Lockhart, TX 78644-2059

Phone

(512) 398-4896

NPI assigned

Jun 12, 2006

Sex

Male

Sole proprietor

Yes

Organizations & group practices 2

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.

• Geriatric Evaluation & Mental Clinical Psychologist · Austin, TX · NPI 1225208200
  NPD (past) CLINICAL
• Senior Connections of Texas, PLLC Clinical Psychologist · Austin, TX · NPI 1831368703
  NPD (past) CLINICAL

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Philosophy

Practice roles

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 Mar 27, 2017.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490572800000",
    "number": "1174565121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 W PRAIRIE LEA ST",
            "city": "LOCKHART",
            "state": "TX",
            "postal_code": "786442555",
            "telephone_number": "512-398-4896",
            "fax_number": "512-398-4896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 FIR LN",
            "city": "LOCKHART",
            "state": "TX",
            "postal_code": "786442059",
            "telephone_number": "512-398-4896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "DAVID",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2017-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "31422",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "31422",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PRIVATE PRACTICE",
            "identifier": "00000042ME",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1409500-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Amanda Gail Ladd, PA-C
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All providers in Lockhart, TX · Psychologist in Texas