Individual provider Active NPI

Katherine T. Kelly, PH.D.

  • Clinical Psychologist
  • Winston Salem, NC
National Provider Identifier
1407822372
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2729 Issued in NC
Practice address
1001 Reynolda Rd
Stockton Cottage
Winston-Salem, NC 27104-3245
Phone
(336) 723-1011
Fax
(336) 723-1411
NPI assigned
Feb 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 2729 NC Primary

Addresses

Primary practice location

1001 Reynolda Rd
Stockton Cottage
Winston-Salem, NC 27104-3245

Mailing address

148 Carrisbrooke LN
Winston-Salem, NC 27104-2528
Phone (336) 406-8431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040901001381 NC Practitioner - Clinical Psychologist 7416922349 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2990 Bethesda PL
Suite 602a
Winston Salem, NC 27103-3314
Phone (336) 659-3923

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2729NCMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Katherine T. Kelly, PH.D., LLC CurrentSince Apr 17, 2007 Accepting new patients

Locations

3000 Bethesda Pl
Ste 201
Winston Salem, NC 27103
Phone (336) 659-3923

1001 Reynolda Rd
Winston Salem, NC 27104
Phone (336) 721-7600

2990 Bethesda Pl
Ste 602A
Winston Salem, NC 27103
Phone (336) 659-3923

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1407822372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 CARRISBROOKE LN",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271042528",
            "telephone_number": "336-406-8431",
            "fax_number": "336-732-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 REYNOLDA RD",
            "address_2": "STOCKTON COTTAGE",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271043245",
            "telephone_number": "336-723-1011",
            "fax_number": "336-723-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KATHERINE",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-28",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "2729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.