Kenneth E Callis, PHD

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

00699 Issued in MO

Practice address

2751 Thomas Dr
Cape Girardeau, MO 63701-2131

Phone

(573) 334-2889

Fax

(573) 651-9152

NPI assigned

May 4, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alpha Medical, LLC

  • Durable Medical Equipment & Medical Supplies
  • Cape Girardeau, MO
  • NPI 1821553793
  NPD Authorized official
• Denise Essners & Associates

  • Clinical Social Worker
  • Cape Girardeau, MO
  • NPI 1508078338
  NPD (past)

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316159114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2751 THOMAS DR",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637012131",
            "telephone_number": "573-334-2889",
            "fax_number": "573-651-9152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2751 THOMAS DR",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637012131",
            "telephone_number": "573-334-2889",
            "fax_number": "573-651-9152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLIS",
        "first_name": "KENNETH",
        "middle_name": "E",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MO",
            "license": "00699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4558",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shatavia Renee Cagle
• April Cain, LPN
• Lynne E Cairns, LCSW
• Amy J Calice, MSN-FNP
• Kevin Wayne Callahan, C.R.N.A.
• Carly Lynn Cameron, DMD
• Ashley Camp, PA-C
• James W. Campbell, M.D.
• Teresa Ann Campbell, LPC
• Cancer Institute of Cape Girardeau, LLC

• Cognitive & Behavioral Psychologist in Cape Girardeau, MO
• Providers in Cape Girardeau, MO by specialty
• Cognitive & Behavioral Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.