Active NPI
Kimberley S Kelly, LMHC, LMSW, IADC
- Mental Health Counselor
- Ottumwa, IA
National Provider Identifier
1750363263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 001380
- Practice address
- 310 W. Main St
Ottumwa, IA 52501 - Phone
- (641) 683-6747
- Fax
- (641) 683-6317
- NPI assigned
- Nov 18, 2005
- Last updated
- May 8, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 03163 | IA | |
| Mental Health Counselor | 101YM0800X | 001380 | IA | Primary |
Addresses
Primary practice location
310 W. Main St
Ottumwa, IA 52501
Mailing address
PO Box 658
Ottumwa, IA 52501-0658
Phone (641) 683-6747
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 228839 | Other | IA | MIDLANDS CHOICE |
Other names 1
- Kim Kelly
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
| License | State | Type | Specialty |
|---|---|---|---|
| 001380 | IA | MD | Mental Health Counselor |
| 03163 | IA | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Iowa Economic Development Assoc | Past | Accepting new patients | |
| United Community Services, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
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-
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- West Des Moines, IA
- NPI 1609998137
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494201600000",
"number": "1750363263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 658",
"city": "OTTUMWA",
"state": "IA",
"postal_code": "525010658",
"telephone_number": "641-683-6747",
"fax_number": "641-682-1924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 W. MAIN ST",
"city": "OTTUMWA",
"state": "IA",
"postal_code": "52501",
"telephone_number": "641-683-6747",
"fax_number": "641-683-6317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "KIMBERLEY",
"middle_name": "S",
"credential": "LMHC, LMSW, IADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-18",
"last_updated": "2017-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IA",
"license": "03163",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IA",
"license": "001380",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MIDLANDS CHOICE",
"identifier": "228839",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KIM",
"last_name": "KELLY",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Ottumwa, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.