Active NPI
Kellie Hetherington, DPM
- Foot & Ankle Surgery Podiatrist
- Lubbock, TX
National Provider Identifier
1285006809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- 338
- Practice address
- 3510 4TH St
Lubbock, TX 79415-3329 - Phone
- (806) 472-3400
- NPI assigned
- Oct 22, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 338 | OK | Primary |
Addresses
Primary practice location
3510 4TH St
Lubbock, TX 79415-3329
Mailing address
1600 Fillmore St Apt 310
Denver, CO 80206-1579
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 338 | OK | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642550400000",
"number": "1285006809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 FILLMORE ST APT 310",
"city": "DENVER",
"state": "CO",
"postal_code": "802061579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3510 4TH ST",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794153329",
"telephone_number": "806-472-3400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HETHERINGTON",
"first_name": "KELLIE",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-22",
"last_updated": "2022-01-19",
"certification_date": "2022-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "OK",
"license": "338",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; 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.