Active NPI
Debra Killackey
- Social Worker
- Fort Myers, FL
National Provider Identifier
1417223207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- SW9555
- Practice address
- 9470 Healthpark Cir
Fort Myers, FL 33908-3600 - Phone
- (239) 433-8073
- Fax
- (239) 482-7897
- NPI assigned
- Mar 27, 2012
- Last updated
- Mar 27, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | SW9555 | FL | Primary |
Addresses
Primary practice location
9470 Healthpark Cir
Fort Myers, FL 33908-3600
Mailing address
9470 Healthpark Cir
Fort Myers, FL 33908-3600
Phone (239) 433-8073
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW9555 | FL | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Client Care LLC | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Advanced Client Care
- Mental Health Counselor
- Boca Raton, FL
- NPI 1245788181
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332806400000",
"number": "1417223207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9470 HEALTHPARK CIR",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339083600",
"telephone_number": "239-433-8073",
"fax_number": "239-482-7897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9470 HEALTHPARK CIR",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339083600",
"telephone_number": "239-433-8073",
"fax_number": "239-482-7897"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KILLACKEY",
"first_name": "DEBRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-27",
"last_updated": "2012-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "FL",
"license": "SW9555",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; 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.