Active NPI
Carolin E Misner, PSYD
- Clinical Psychologist
- Kettering, OH
National Provider Identifier
1760580005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 5134
- Practice address
- 4532 Royal Ridge Way
Kettering, OH 45429-1300 - Phone
- (937) 424-1564
- Fax
- (937) 424-1565
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 5134 | OH | Primary |
Addresses
Primary practice location
4532 Royal Ridge Way
Kettering, OH 45429-1300
Mailing address
4532 Royal Ridge Way
Kettering, OH 45429-1300
Phone (937) 424-1564
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2009463 | Medicaid | OH | |
| 000000031378 | Other | OH | ANTHEM BC/BS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5134 | OH | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184112000000",
"number": "1760580005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4532 ROYAL RIDGE WAY",
"city": "KETTERING",
"state": "OH",
"postal_code": "454291300",
"telephone_number": "937-424-1564",
"fax_number": "937-424-1565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4532 ROYAL RIDGE WAY",
"city": "KETTERING",
"state": "OH",
"postal_code": "454291300",
"telephone_number": "937-424-1564",
"fax_number": "937-424-1565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MISNER",
"first_name": "CAROLIN",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "5134",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2009463",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BC/BS",
"identifier": "000000031378",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kettering, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.