Kelly Jo Shada, R.N.,L.M.H.P.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

423 Issued in NE

Practice address

5205 2ND Ave
Kearney, NE 68847-2471

Phone

(308) 236-7545

Fax

(308) 236-7545

NPI assigned

Feb 12, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

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.

• Family Network PC

  • Mental Health Counselor
  • Kearney, NE
  • NPI 1447794219
  NPD (past) Authorized official

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427190040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5205 2ND AVE",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688472471",
            "telephone_number": "308-236-7545",
            "fax_number": "308-236-7545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5205 2ND AVE",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688472471",
            "telephone_number": "308-236-7545",
            "fax_number": "308-236-7545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADA",
        "first_name": "KELLY",
        "middle_name": "JO",
        "name_prefix": "Mrs.",
        "credential": "R.N.,L.M.H.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NE",
            "license": "423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "84306",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS CHOICE",
            "identifier": "25690",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Leigh Self
• Serene Mental Health Clinic LLC
• Serene Mental Health Clinic LLC
• McKenzie Lynne Severe, MS, PLMHP
• Sarah Seward, OTA
• Ellen Katherine Shafer-Lind, LMSW
• Angela Shafer
• Brylee Shafer
• Kenton L Shaffer, MD
• Robert R Shaffer, M.D.

• Mental Health Counselor in Kearney, NE
• Providers in Kearney, NE by specialty
• Mental Health Counselor in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.