Krista Michelle McDonald, LSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.018860 Issued in IL

Practice address

220 E State St Ste 2a
O Fallon, IL 62269-1443

Phone

(618) 402-4676

NPI assigned

Jul 29, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Krista Herndon Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599955200000",
    "number": "1245615426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 E STATE ST STE 2A",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691443",
            "telephone_number": "618-402-4676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 E STATE ST STE 2A",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691443",
            "telephone_number": "618-402-4676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "KRISTA",
        "middle_name": "MICHELLE",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-29",
        "last_updated": "2020-09-13",
        "certification_date": "2020-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.018860",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150.015484",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTA",
            "last_name": "HERNDON",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kevin James McCarthy, M.D.
• Todd Matthew McClew, CRNA
• Lori Ann McCormick
• Jessica McDaniel, MA LPC
• Bailey McDonald
• Lynita Irene McDougald, RBT
• Aideen McEnaney, OD
• Rodnica McGee, BT
• Michael Martin McGuire, PA-C, ATC
• Casey McHaney

• Clinical Social Worker in O'Fallon, IL
• Providers in O'Fallon, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.