Active NPI
Amy E Kersten, LCSW
- Clinical Social Worker
- Waynesville, MO
National Provider Identifier
1366401408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 536
- Practice address
- 119 N Benton St
Waynesville, MO 65583-2501 - Phone
- (573) 433-2833
- NPI assigned
- Mar 18, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 536 | AK | Primary |
Addresses
Primary practice location
119 N Benton St
Waynesville, MO 65583-2501
Mailing address
15857 Terris LN
Saint Robert, MO 65584-7505
Phone (907) 687-2963
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MH8832 | Medicaid | AK |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 536 | AK | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
| Benton Street Counseling LLC | Clinical | Past | Accepting new patients |
| Fairbanks Psychiatric and Neurological Clinic a Prof Corp | Past | Accepting new patients | |
| Benton Street Counseling LLC | Clinical | Past | Accepting new patients |
Interoperability endpoints
- amykersten@tdh.allscriptsdirect.net
Organizations & group practices 4
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.
-
- Neurology Physician
- Fairbanks, AK
- NPI 1518075100
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425772800000",
"number": "1366401408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15857 TERRIS LN",
"city": "SAINT ROBERT",
"state": "MO",
"postal_code": "655847505",
"telephone_number": "907-687-2963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 N BENTON ST",
"city": "WAYNESVILLE",
"state": "MO",
"postal_code": "655832501",
"telephone_number": "573-433-2833"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERSTEN",
"first_name": "AMY",
"middle_name": "E",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-18",
"last_updated": "2015-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AK",
"license": "536",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "MH8832",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waynesville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.