Individual provider Active NPI

Ksenia A. Caillouet, MHPP

  • Case Manager/Care Coordinator
  • Bentonville, AR
National Provider Identifier
1346458296
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
2003 SE Walton Blvd
Bentonville, AR 72712-3725
Phone
(479) 464-5923
Fax
(479) 464-4275
NPI assigned
May 21, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X Primary

Addresses

Primary practice location

2003 SE Walton Blvd
Bentonville, AR 72712-3725

Mailing address

4253 N Crossover Rd
Fayetteville, AR 72703-4593
Phone (479) 521-5731

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346458296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4253 N CROSSOVER RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034593",
            "telephone_number": "479-521-5731",
            "fax_number": "479-521-6520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 SE WALTON BLVD",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123725",
            "telephone_number": "479-464-5923",
            "fax_number": "479-464-4275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAILLOUET",
        "first_name": "KSENIA",
        "middle_name": "A.",
        "credential": "MHPP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

  • 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.