Active NPI
Kelli L Smart, PSYCHOLOGIST
- School Psychologist
- Prescott Valley, AZ
National Provider Identifier
1184769820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- Practice address
- 8766 East Hwy 69
Humboldt Unified School District #22 Special Service
Prescott Valley, AZ 86314 - Phone
- (928) 759-4028
- Fax
- (928) 759-4030
- NPI assigned
- Feb 20, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | AZ | Primary |
Addresses
Primary practice location
8766 East Hwy 69
Humboldt Unified School District #22 Special Service
Prescott Valley, AZ 86314
Mailing address
1196 Buena Vista W
Dewey, AZ 86327
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 710295 | Medicaid | AZ |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185408000000",
"number": "1184769820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1196 BUENA VISTA W",
"city": "DEWEY",
"state": "AZ",
"postal_code": "86327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8766 EAST HWY 69",
"address_2": "HUMBOLDT UNIFIED SCHOOL DISTRICT #22 SPECIAL SERVICE",
"city": "PRESCOTT VALLEY",
"state": "AZ",
"postal_code": "86314",
"telephone_number": "928-759-4028",
"fax_number": "928-759-4030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMART",
"first_name": "KELLI",
"middle_name": "L",
"credential": "PSYCHOLOGIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-20",
"last_updated": "2007-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "AZ",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "710295",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Prescott Valley, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.