Judith A Kellenberger

Primary specialty

PsychologistTaxonomy code 103T00000X

License

01618 Issued in MO

Practice address

1230 N Duquesne Rd
Joplin, MO 64801-1509

Phone

(417) 782-1443

NPI assigned

Mar 24, 2006

Sex

Female

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 1

Other names 1

• Judith A Garrity Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405382400000",
    "number": "1619937414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 ALPACA RD",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648048735",
            "telephone_number": "417-781-9160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 N DUQUESNE RD",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648011509",
            "telephone_number": "417-782-1443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLENBERGER",
        "first_name": "JUDITH",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-24",
        "last_updated": "2014-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MO",
            "license": "01618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "496912734",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUDITH",
            "last_name": "GARRITY",
            "middle_name": "A",
            "credential": "M.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Catherine Elizabeth Keeney, CCC-SLP
• Chad Eric Keeney, DO
• Emily Leann Keeslar, DO
• Keith Walker Opticians
• John David Keitz, D.O.
• John Stewart Kelley, LPC
• Terrence Kelly, DO
• Danielle Christine Keltner
• Ghaila Chinasa Keng, M.D
• Erinne Nicole Kennedy, DMD

• Psychologist in Joplin, MO
• Providers in Joplin, MO by specialty
• Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; 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.

Verify at the official NPI Registry.