Active NPI
Kaitlyn Rose Kelley
- School Psychologist
- Saint Jacob, IL
National Provider Identifier
1386108173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- Practice address
- 2575 Triad Rd
Saint Jacob, IL 62281-1125 - Phone
- (618) 978-5847
- NPI assigned
- Jan 25, 2019
- Last updated
- Jan 25, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | Primary |
Addresses
Primary practice location
2575 Triad Rd
Saint Jacob, IL 62281-1125
Mailing address
2575 Triad Rd
Saint Jacob, IL 62281-1125
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": "1548374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548374400000",
"number": "1386108173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2575 TRIAD RD",
"city": "SAINT JACOB",
"state": "IL",
"postal_code": "622811125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2575 TRIAD RD",
"city": "SAINT JACOB",
"state": "IL",
"postal_code": "622811125",
"telephone_number": "618-978-5847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "KAITLYN",
"middle_name": "ROSE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-25",
"last_updated": "2019-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Jacob, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.