Andrea L Skelton, LSCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3910 Issued in KS

Practice address

1333 N Broadway Ave
Suite E
Wichita, KS 67214-2894

Phone

(316) 201-1676

Fax

(316) 201-1762

NPI assigned

Jul 18, 2006

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 identifiers 1

Other names 1

• Andrea L Pennock Former name

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Phoenix Risng Therapy, LLC

  dba Phoenix Rising Therapy, LLC

  • Clinical Social Worker
  • Derby, KS
  • NPI 1679311070
  NPD Authorized official
• Gulf Coast Therapy Center

  • Mental Health Counselor
  • Nokomis, FL
  • NPI 1710517412
  NPD (past)

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508025600000",
    "number": "1265450886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 N BROADWAY AVE STE E",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672142894",
            "telephone_number": "316-201-1676",
            "fax_number": "316-201-1762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 N BROADWAY AVE",
            "address_2": "SUITE E",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672142894",
            "telephone_number": "316-201-1676",
            "fax_number": "316-201-1762"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1333 N Broadway Ave",
            "address_2": "Suite E",
            "address_purpose": "LOCATION",
            "city": "Wichita",
            "state": "KS",
            "postal_code": "672142894",
            "country_code": "US",
            "telephone_number": "316-201-1676",
            "fax_number": "316-201-1762",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SKELTON",
        "first_name": "ANDREA",
        "middle_name": "L",
        "credential": "LSCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2017-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KS",
            "license": "198",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KS",
            "license": "3910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200654090C",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "PENNOCK",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Janny Ketsana Sivilay, LSCSW
• Johnathan Sivilay, PA-C
• Size and Fit, LLC (New Balance)
• Kathryn Elizabeth Sjoholm, CRNA
• Delaney Kaylene Skaggs
• Valerie Christine Skender, PT
• Caitlyn Sketchley Castelli, LMSW
• Richard M Skibba, MD
• Michael Skidmore, RN
• Braxton Skiles, CRNA

• Clinical Social Worker in Wichita, KS
• Providers in Wichita, KS by specialty
• Clinical Social Worker in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.