Individual provider Active NPI

Kathryn Sue Crain, M.ED

  • Child Mental Illness Respite Care
  • Yuma, AZ
National Provider Identifier
1386707305
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child Mental Illness Respite CareTaxonomy code 385HR2055X
License
10454 Issued in AZ
Practice address
1885 S 5TH Ave
Yuma, AZ 85364-5559
Phone
(928) 782-6172
NPI assigned
Dec 19, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child Mental Illness Respite Care 385HR2055X 10454 AZ Primary

Addresses

Primary practice location

1885 S 5TH Ave
Yuma, AZ 85364-5559

Mailing address

1885 S 5TH Ave
Yuma, AZ 85364-5559
Phone (928) 782-6172

Other identifiers 1

IdentifierTypeStateIssuer
968828MedicaidAZ

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
Credentials
Master of Education

State licenses

LicenseStateTypeSpecialty
10454AZMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1386707305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1885 S 5TH AVE",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853645559",
            "telephone_number": "928-782-6172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1885 S 5TH AVE",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853645559",
            "telephone_number": "928-782-6172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAIN",
        "first_name": "KATHRYN",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "M.ED",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-19",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "385HR2055X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Mental Illness, Child",
            "state": "AZ",
            "license": "10454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "968828",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yuma, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.