Active NPI
Kendall Jasper, PH.D.
- Clinical Psychologist
- Charlotte, NC
National Provider Identifier
1720106743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4088
- Practice address
- 223 W Morehead St
Charlotte, NC 28202-1521 - Phone
- (980) 819-5692
- Fax
- (980) 819-5694
- NPI assigned
- Mar 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4088 | NC | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 4088 | NC | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 4088 | NC | |
| Community/Behavioral Health Agency | 251S00000X | 4088 | NC |
Addresses
Primary practice location
223 W Morehead St
Charlotte, NC 28202-1521
Mailing address
223 W Morehead St
Charlotte, NC 28202-1521
Phone (980) 819-5692
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6107205 | Medicaid | NC |
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
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arj SC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Case Management Agency
- Charlotte, NC
- NPI 1184087546
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459728000000",
"number": "1720106743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "223 W MOREHEAD ST",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282021521",
"telephone_number": "980-819-5692",
"fax_number": "980-819-5694"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "223 W MOREHEAD ST",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282021521",
"telephone_number": "980-819-5692",
"fax_number": "980-819-5694"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JASPER",
"first_name": "KENDALL",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-27",
"last_updated": "2016-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "4088",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NC",
"license": "4088",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "NC",
"license": "4088",
"primary": false
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "NC",
"license": "4088",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6107205",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.