Kelly Lynn Quakenbush, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

Q0075 Issued in TX

Practice address

111 Dallas St Ste 201
Argyle, TX 76226

Phone

(940) 277-7373

Fax

(214) 279-7556

NPI assigned

Apr 28, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Lynn Irvin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Sep 1, 2023 through Sep 1, 2027

Specialty

Psychiatry

Education

Other, 2009

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

Locations

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.

• Intentional Life Psychiatry PLLC

  • Psychiatry Physician
  • Argyle, TX
  • NPI 1841063856
  NPD

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

{
    "created_epoch": "1240876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718409600000",
    "number": "1255575718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 DALLAS ST STE 201",
            "city": "ARGYLE",
            "state": "TX",
            "postal_code": "76226",
            "telephone_number": "940-277-7373",
            "fax_number": "214-279-7556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 DALLAS ST STE 201",
            "city": "ARGYLE",
            "state": "TX",
            "postal_code": "76226",
            "telephone_number": "940-277-7373",
            "fax_number": "214-279-7556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUAKENBUSH",
        "first_name": "KELLY",
        "middle_name": "LYNN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-28",
        "last_updated": "2024-06-15",
        "certification_date": "2024-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "Q0075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "IRVIN",
            "middle_name": "LYNN",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Psychiatry Physician in Argyle, TX
• Providers in Argyle, TX by specialty
• Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.