Active NPI
Kelly Renee Dardeen, PH.D.
- Psychologist
- West Lafayette, IN
National Provider Identifier
1235382128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 20042319A
- Practice address
- 1241 Cumberland Ave
West Lafayette, IN 47906-1304 - Phone
- (812) 629-4999
- Fax
- (765) 607-1483
- NPI assigned
- Oct 23, 2008
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 20042319A | IN | Primary |
Addresses
Primary practice location
1241 Cumberland Ave
West Lafayette, IN 47906-1304
Mailing address
1241 Cumberland Ave
West Lafayette, IN 47906-1304
Phone (812) 629-4999
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000001056306 | Other | IN | ANTHEM PROVIDER NUMBER |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Suncrest Psychological Services | Past | Accepting new patients | |
| Locker Psychological Services, LLC | Psychologist | Past | Accepting new patients |
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.
-
- Clinical Psychologist
- West Lafayette, IN
- NPI 1831615665
-
- Clinical Psychologist
- West Lafayette, IN
- NPI 1740057165
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701388800000",
"number": "1235382128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1241 CUMBERLAND AVE",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479061304",
"telephone_number": "812-629-4999",
"fax_number": "765-607-1483"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1241 CUMBERLAND AVE",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479061304",
"telephone_number": "812-629-4999",
"fax_number": "765-607-1483"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DARDEEN",
"first_name": "KELLY",
"middle_name": "RENEE",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-23",
"last_updated": "2023-12-01",
"certification_date": "2023-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IN",
"license": "20042319A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROVIDER NUMBER",
"identifier": "000001056306",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.