Active NPI
Kerrey Bogardus
- Clinical Psychologist
- Phoenix, AZ
National Provider Identifier
1235967811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY-T-000063
- Practice address
- 4225 E Windrose Dr Ste 300
Phoenix, AZ 85032-7585 - Phone
- (480) 779-0727
- NPI assigned
- Jul 24, 2024
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY-T-000063 | AZ | Primary |
Addresses
Primary practice location
4225 E Windrose Dr Ste 300
Phoenix, AZ 85032-7585
Mailing address
1934 E Sheena Dr
Phoenix, AZ 85022-4553
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 |
|---|---|---|---|
| PSY-T-000063 | AZ | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Autism Behavioral Ventures LLC | 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.
-
dba Ascend Behavior Partners
- Behavior Analyst
- Denver, CO
- NPI 1124532718
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721779200000",
"number": "1235967811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1934 E SHEENA DR",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850224553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4225 E WINDROSE DR STE 300",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850327585",
"telephone_number": "480-779-0727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGARDUS",
"first_name": "KERREY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-24",
"last_updated": "2024-07-24",
"certification_date": "2024-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AZ",
"license": "PSY-T-000063",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.