Sharon L Kelley, LCSW
Individual provider Active NPI Clinical Social Worker · Ava, MO
NPI 1720053689 · NPPES record last updated Feb 23, 2015
Key facts
- NPI
- 1720053689
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 1999135384 (MO)
- Practice address
- 504 NW 10TH
Ava, MO 65608-1359 - Phone
- (417) 683-5739
- Fax
- (417) 683-1602
- NPI assigned
- Feb 22, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1999135384 | MO | MD | Clinical Social Worker |
| 10398 | FL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Douglas County Public Health Services Group, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 10398 | FL | |
| Clinical Social Worker | 1041C0700X | 1999135384 | MO | Yes |
Addresses
Primary practice location
504 NW 10TH
Ava, MO 65608-1359
Mailing address
PO Box 1359
Ava, MO 65608-1359
Phone (417) 683-5739
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00122802 | Other | RAILROAD MEDICARE | |
| 499145522 | Medicaid | MO | |
| 499145514 | Medicaid | MO | |
| 004856200 | Medicaid | FL | |
| 499145506 | Medicaid | MO | |
| 189212 | Other | BLUE CROSS BLUE SHIELD |
Other providers in Ava, MO
- Micah Nicole Hubbard
- Rebecca L Johnson
- Candace K Jones
- Ida N Junge
- Zachary Keith
- Youngmyong M Kim
- April Dawn Kimball
- Jordan Lynn King
- Judy King
- Elena P Kuz
All providers in Ava, MO · Clinical Social Worker in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.