Kimberly Ann Kelly, PH. D., MA, MED

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

315 5TH Ave
Fairbanks, AK 99701-5025

Phone

(907) 374-7776

Fax

(800) 988-7650

NPI assigned

Oct 6, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Master of Arts, Master of Education, Doctor of Philosophy

Practice roles

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.

• Turning Point LLC

  • Community/Behavioral Health Agency
  • Fairbanks, AK
  • NPI 1619108677
  NPD (past)

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

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1376205492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 5TH AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015025",
            "telephone_number": "907-374-7776",
            "fax_number": "800-988-7650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 5TH AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015025",
            "telephone_number": "907-374-7776",
            "fax_number": "800-988-7650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "PH. D., MA, MED",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-06",
        "last_updated": "2021-10-06",
        "certification_date": "2021-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Ann Kekoni
• Cary S Keller, M.D.
• Joy Keller, CDM
• Ashley Kelley, LPC
• Lamozae Kelley I
• Larry Wayne Kelly Jr., PMHNP
• Myra Lynn Kelly, APRN
• Staysha Kelly
• Terry Kelly, LPC
• Surech Dawn Kemesong

• Mental Health Counselor in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Mental Health Counselor in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.