Kevin Thomas Kelly, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY9275 Issued in CA

Practice address

598 Cochrane Ave
Ukiah, CA 95482-5621

Phone

(707) 463-1447

Fax

(866) 204-9690

NPI assigned

Aug 20, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187568000000",
    "number": "1508059080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "598 COCHRANE AVE",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954825621",
            "telephone_number": "707-463-1447",
            "fax_number": "866-204-9690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "598 COCHRANE AVE",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954825621",
            "telephone_number": "707-463-1447",
            "fax_number": "866-204-9690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KEVIN",
        "middle_name": "THOMAS",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-20",
        "last_updated": "2007-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY9275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD UIC #",
            "identifier": "A00PL92750",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PIN",
            "identifier": "7809105",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "PA0092759",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD SUBMITTER",
            "identifier": "#00PL92750",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "PSY00009275",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Helen Kee, O.D.
• Keffeler Pharmaceutical Inc
• Tim Keffeler, PHARM.D.
• Keith F. Korver, M.D., Inc.
• Lisa Keller
• Kristy Anne Kelly, MFT
• Sean Christopher Kelly, M.D.
• Victoria J Kelly, LCSW
• Terrance Harold Kennedy, LCSW
• Lexxi N Kerrigan

• Psychologist in Ukiah, CA
• Providers in Ukiah, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.