Active NPI
Kristell M Kotara, LCSW-S
- Clinical Social Worker
- Amarillo, TX
National Provider Identifier
1609000876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 53549
- Practice address
- 6010 W Amarillo Blvd
Amarillo, TX 79106-1990 - Phone
- (806) 355-9703
- NPI assigned
- May 4, 2009
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 53549 | TX | Primary |
Addresses
Primary practice location
6010 W Amarillo Blvd
Amarillo, TX 79106-1990
Mailing address
6010 Amarillo Boulevard West
Amarillo, TX 79106
Phone (806) 355-9703
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53549 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586736000000",
"number": "1609000876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6010 AMARILLO BOULEVARD WEST",
"city": "AMARILLO",
"state": "TX",
"postal_code": "79106",
"telephone_number": "806-355-9703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6010 W AMARILLO BLVD",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791061990",
"telephone_number": "806-355-9703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOTARA",
"first_name": "KRISTELL",
"middle_name": "M",
"credential": "LCSW-S",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-04",
"last_updated": "2020-04-13",
"certification_date": "2020-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "53549",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amarillo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.