Individual provider Active NPI

Kaylee B Crockett, PHD

  • Clinical Psychologist
  • Birmingham, AL
National Provider Identifier
1740720853
Registry record updated Nov 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2118 Issued in AL
Practice address
1201 11TH Ave S Ste 410
Birmingham, AL 35205-3423
Phone
(205) 934-9700
NPI assigned
Mar 8, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Psychologist 103TH0100X
Clinical Psychologist 103TC0700X 2118 AL Primary

Addresses

Primary practice location

1201 11TH Ave S Ste 410
Birmingham, AL 35205-3423

Mailing address

1201 11TH Ave S Ste 410
Birmingham, AL 35205-3423
Phone (770) 312-7070

Other practice location 1

997 Saint Sebastian Way
Augusta, GA 30912-2613
Phone (706) 712-3530

Other names 1

  • Kaylee E Burnham Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201116001072 AL Practitioner - Clinical Psychologist 1254742661 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Alabama Health Services Foundation, PCGroup PAC ID 1951213107, 2,784 clinicians

Practice addresses (Care Compare)

619 19TH St S
Birmingham, AL 35246-0001
Phone (205) 934-3460

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2118ALMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
University of Alabama Health Services Foundation, PC. CurrentSince Nov 1, 2020 Accepting new patients

Locations

1201 11th Ave S
Ste 410
Birmingham, AL 35205
Phone (205) 682-6056

619 19th St S
Birmingham, AL 35249

619 19th St S
Birmingham, AL 35233
Phone (205) 934-6405

Interoperability endpoints

  • Direct secure messaging: kcrockett@direct.uabmedicine.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1488931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604880000000",
    "number": "1740720853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 11TH AVE S STE 410",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352053423",
            "telephone_number": "770-312-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 11TH AVE S STE 410",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352053423",
            "telephone_number": "205-934-9700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "997 Saint Sebastian Way",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309122613",
            "country_code": "US",
            "telephone_number": "706-712-3530",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "KAYLEE",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-08",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AL",
            "license": "2118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAYLEE",
            "last_name": "BURNHAM",
            "middle_name": "E",
            "credential": "PHD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Birmingham, AL

Sources for this page

Verify at the official NPI Registry.