Katherine Chemodurow Kelley, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A116071 Issued in CA

Practice address

1465 W Chandler Blvd BLDG a
Chandler, AZ 85224-6237

Phone

(480) 786-8200

NPI assigned

Aug 6, 2007

Last updated

Nov 14, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Dr. Katherine Chemodurow Former name

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.katherinechemodurowkelley@148377.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southwest Network

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1104856004
  Medicare reassignment NPD
• Southwest Network, Inc.

  dba Southwest Network

  • Community/Behavioral Health Agency
  • Chandler, AZ
  • NPI 1487981338

  Family Medicine

  NPD
• Southwest Network, Inc.

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1912164039

  Family Medicine

  NPD
• Pacific Coast Psychiatric Associates Inc

  dba Lifestance Health

  • Clinical Psychologist
  • Scottsdale, AZ
  • NPI 1023125465

  Psychiatry

  NPD (past)

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

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731542400000",
    "number": "1386835106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 N CENTRAL AVE STE 1050",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850041217",
            "telephone_number": "602-376-3353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 W CHANDLER BLVD BLDG A",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852246237",
            "telephone_number": "480-786-8200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1840 N 95th Ave Ste 132",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850374445",
            "country_code": "US",
            "telephone_number": "623-932-6950",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2311 W Royal Palm Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850214924",
            "country_code": "US",
            "telephone_number": "602-269-5300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3227 W Royal Palm Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850516134",
            "country_code": "US",
            "telephone_number": "602-269-5300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "KATHERINE",
        "middle_name": "CHEMODUROW",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-06",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A116071",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AZ",
            "license": "43926",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "30101",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "CHEMODUROW",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kell Jorn Cook, D.D.S., P.C.
• Kristen Jo Keller, DNP, ACNP-BC
• Lisa Keller, PA-C
• Kellerlife, LLC (KellerLife Center for Eating Disorders)
• Joshua Paul Kelley, M.D.
• Keith Michael Kelley, APRN-RNP, FNP-C
• Mackenzie Kelley
• Christopher M Kellogg, MD
• David Norris Kells, M.D.
• Kailey R Kelly, PA

• Psychiatry Physician in Chandler, AZ
• Providers in Chandler, AZ by specialty
• Psychiatry Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.