Individual provider Active NPI

Kristina Michele Isaacs, MA, LP

  • Psychologist
  • South Charleston, WV
National Provider Identifier
1770121287
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1226 Issued in WV
Practice address
313 Maccorkle Ave SW
South Charleston, WV 25303-1205
Phone
(304) 525-7851
Fax
(304) 525-1073
NPI assigned
Dec 16, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 1226 WV Primary

Addresses

Primary practice location

313 Maccorkle Ave SW
South Charleston, WV 25303-1205

Mailing address

99 Cracker Barrel Dr Ste 100
Barboursville, WV 25504-1650
Phone (304) 525-7851

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20200219002058 WV Practitioner - Clinical Psychologist 8628405388 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

Practice roles

OrganizationSpecialtyStatusNew patients
Prestera Center for Mental Health Services Inc CurrentSince Dec 23, 2019 Accepting new patients
Prestera Center for Mental Health Services Inc CurrentSince Dec 23, 2019 Accepting new patients
Prestera Center for Mental Health Services Inc Past Accepting new patients

Locations

99 Cracker Barrel Dr
Ste 100
Barboursville, WV 25504
Phone 30452578512514

511 Morris St
Charleston, WV 25301
Phone (304) 341-0511

376 Kenmore Dr
Danville, WV 25053
Phone (304) 369-1930

4020 US Route 60
Huntington, WV 25705
Phone (304) 399-1177

55 Donohoe Dr
Huntington, WV 25705

313 Maccorkle Ave SW
South Charleston, WV 25303
Phone (304) 744-2300

Organizations & group practices 3

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": "1576454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724371200000",
    "number": "1770121287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 CRACKER BARREL DR STE 100",
            "city": "BARBOURSVILLE",
            "state": "WV",
            "postal_code": "255041650",
            "telephone_number": "304-525-7851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 MACCORKLE AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253031205",
            "telephone_number": "304-525-7851",
            "fax_number": "304-525-1073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISAACS",
        "first_name": "KRISTINA",
        "middle_name": "MICHELE",
        "credential": "MA, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-16",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WV",
            "license": "1226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

Verify at the official NPI Registry.