Individual provider Active NPI

Kelli Hedgpeth

  • Physical Therapy Assistant
  • Independence, MO
National Provider Identifier
1629498563
Registry record updated Apr 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
2005026651 Issued in MO
Practice address
3980 South Jackson Dr
Independence, MO 64068
Phone
(816) 478-5604
NPI assigned
Apr 18, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 18, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 2005026651 MO Primary

Addresses

Primary practice location

3980 South Jackson Dr
Independence, MO 64068

Mailing address

1133 Silverleaf LN
Liberty, MO 64068-8496

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

LicenseStateTypeSpecialty
2005026651MOMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1397779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397779200000",
    "number": "1629498563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 SILVERLEAF LN",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640688496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3980 SOUTH JACKSON DR",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "64068",
            "telephone_number": "816-478-5604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEDGPETH",
        "first_name": "KELLI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-18",
        "last_updated": "2014-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2005026651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2014; 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.