NPIMap

Individual provider Active NPI

Kevin William Kelly, PSY.D.

  • Clinical Psychologist
  • East Petersburg, PA
National Provider Identifier
1619984309
Registry record updated Feb 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS-008835-L Issued in PA
Practice address
2013 State Street
East Petersburg, PA 17520-1216
Phone
(717) 291-8283
Fax
(717) 581-6528
NPI assigned
Aug 2, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 10, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PS-008835-L PA Primary

Addresses

Primary practice location

2013 State Street
East Petersburg, PA 17520-1216

Mailing address

2013 State Street
East Petersburg, PA 17520-1216
Phone (717) 291-8283

Other identifiers 5

IdentifierTypeStateIssuer
000411068OtherPAHIGHMARK BLUE SHIELD #
01786901OtherPACAPITAL BLUE CROSS PROV#
458436OtherPAVALUE OPTIONS PROV #
P00180931OtherPARAILROAD MEDICARE PROV #
02695800OtherPACAPITAL BLUE CROSS PRACT#

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

LicenseStateTypeSpecialty
PS-008835-LPAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Philhaven Past Accepting new patients
Palliative Medicine Consultants Past Accepting new patients
Vohra Post Acute Care Physicians of the Northeast PA Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265760000000",
    "number": "1619984309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2013 STATE STREET",
            "city": "EAST PETERSBURG",
            "state": "PA",
            "postal_code": "175201216",
            "telephone_number": "717-291-8283",
            "fax_number": "717-581-6528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2013 STATE STREET",
            "city": "EAST PETERSBURG",
            "state": "PA",
            "postal_code": "175201216",
            "telephone_number": "717-291-8283",
            "fax_number": "717-581-6528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KEVIN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2010-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS-008835-L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD #",
            "identifier": "000411068",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS PROV#",
            "identifier": "01786901",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS PROV #",
            "identifier": "458436",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PROV #",
            "identifier": "P00180931",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS PRACT#",
            "identifier": "02695800",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Petersburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2010; 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.