Active NPI
Kelly Buckingham
- Clinical Social Worker
- Sheridan, WY
National Provider Identifier
1568786770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 634
- Practice address
- 1876 S Sheridan Ave
Sheridan, WY 82801-6136 - Phone
- (307) 672-0475
- Fax
- (307) 674-6867
- NPI assigned
- Mar 16, 2010
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 340 | WY | |
| Clinical Social Worker | 1041C0700X | 4975 | ND | |
| Clinical Social Worker | 1041C0700X | 634 | WY | Primary |
Addresses
Primary practice location
1876 S Sheridan Ave
Sheridan, WY 82801-6136
Mailing address
1876 S Sheridan Ave
Sheridan, WY 82801-6136
Phone (307) 672-0475
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4975 | ND | MD | Clinical Social Worker |
| 634 | WY | MD | Occupational Therapist |
| 340 | WY | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621555200000",
"number": "1568786770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1876 S SHERIDAN AVE",
"city": "SHERIDAN",
"state": "WY",
"postal_code": "828016136",
"telephone_number": "307-672-0475",
"fax_number": "307-674-6867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1876 S SHERIDAN AVE",
"city": "SHERIDAN",
"state": "WY",
"postal_code": "828016136",
"telephone_number": "307-672-0475",
"fax_number": "307-674-6867"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKINGHAM",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-16",
"last_updated": "2021-05-21",
"certification_date": "2021-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WY",
"license": "340",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ND",
"license": "4975",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WY",
"license": "634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sheridan, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.