Individual provider Active NPI

Cheyenne Autumn Hissong

  • Clinical Social Worker
  • Morehead, KY
National Provider Identifier
1366000291
Registry record updated Feb 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801104291 Issued in MI
Practice address
330 25TH Street
Morehead, KY 40351
Phone
(866) 233-1955
NPI assigned
Jun 5, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801104291 MI Primary

Addresses

Primary practice location

330 25TH Street
Morehead, KY 40351

Mailing address

1939 S Division Ave
Grand Rapids, MI 49507
Phone (616) 247-3815

Other names 1

  • Cheyenne Smith Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20250409002557 KY Practitioner - Clinical Social Worker 8022532233 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pathways IncGroup PAC ID 1254239171, 60 clinicians

Practice addresses (Care Compare)

330 25TH St
Ashland, KY 41101-7820
Phone (606) 326-2867

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801104291MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pathways Inc CurrentSince Feb 1, 2025 Accepting new patients
Pathways, Inc CurrentSince Feb 1, 2025 Accepting new patients

Locations

3701 Landsdowne Dr
Ashland, KY 41102
Phone (606) 324-3005

330 25th St
Ashland, KY 41101
Phone (606) 324-4222

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740700800000",
    "number": "1366000291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1939 S DIVISION AVE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49507",
            "telephone_number": "616-247-3815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 25TH STREET",
            "city": "MOREHEAD",
            "state": "KY",
            "postal_code": "40351",
            "telephone_number": "866-233-1955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HISSONG",
        "first_name": "CHEYENNE",
        "middle_name": "AUTUMN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-05",
        "last_updated": "2025-02-28",
        "certification_date": "2025-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801104291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHEYENNE",
            "last_name": "SMITH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Morehead, KY

Sources for this page

Verify at the official NPI Registry.