Kellie King, CSW-INTERN

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

IC-1164 Issued in NV

Practice address

90 Hope Dr BLDG 6000
Mountain Home Afb, ID 83648-1062

Phone

(208) 828-7580

NPI assigned

Dec 12, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1513036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1780199828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 HOPE DR BLDG 6000",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836481062",
            "telephone_number": "208-828-7580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 HOPE DR BLDG 6000",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836481062",
            "telephone_number": "208-828-7580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "KELLIE",
        "credential": "CSW-INTERN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-12",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "IC-1164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Jewkes, PHARMD
• Ryan D Kainrath, IDMT
• Jakob Kamilow
• Krista Marie Kelly, PA-C
• Kristin Kepler, RN, DNP, WHNP-BC
• Casey Elizabeth Lynch, WHNP-BC
• Thomas Madden
• Andrew James Magyan, DO
• Kadeesh McNaught
• Lucas Meehan, MD

• Clinical Social Worker in Mountain Home Afb, ID
• Providers in Mountain Home Afb, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.