Kimberly D Kelly, LCSW, DSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

8566 Issued in OK

Practice address

407 W South Ave
Ponca City, OK 74601-6133

Phone

(580) 749-5056

NPI assigned

Nov 10, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

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

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Grand Lake Mental Health Center, Inc.Group PAC ID 4688711534, 121 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Grand Lake Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Miami, OK
  • NPI 1497762520
  Medicare reassignment Care Compare group NPD
• Grand Lake Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ponca City, OK
  • NPI 1306394788
  NPD
• Grand Lake Mental Health Center, Inc.

  • Community/Behavioral Health Agency
  • Tulsa, OK
  • NPI 1356048656
  NPD

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

{
    "created_epoch": "1668038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668038400000",
    "number": "1336857028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 W SOUTH AVE",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746016133",
            "telephone_number": "580-749-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 W SOUTH AVE",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746016133",
            "telephone_number": "580-749-5056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KIMBERLY",
        "middle_name": "D",
        "credential": "LCSW, DSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-10",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OK",
            "license": "8566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debbie Faye Keeter - Moore, MS. RD/LD.CDE
• Landen Keffer
• Donald Ray Kelle, O.D.
• Kaella R Kelley
• Alice Bayles Kelly, DPH
• Candice I Kemble, MCP, LPC
• Rachel Dawn Kemble
• Rita Rene Kemble, BS
• Princess Danielle Kennedy
• Kenny James, M.S., L.P.C., P.C., LTD.

• Social Worker in Ponca City, OK
• Providers in Ponca City, OK by specialty
• Social Worker in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 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.
• 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.