Kellee D Shepherd, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2021001168 Issued in MO

Practice address

1800 W 30TH St
Joplin, MO 64804-1520

Phone

(417) 347-7580

NPI assigned

Aug 8, 2018

Last updated

Jan 19, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Kellee D Patton Former name

Medicare fee-for-service enrollment

Enrolled in OK

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Grand Lake Mental Health Center, Inc.

  dba GRAND Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Miami, OK
  • NPI 1497762520
  Medicare reassignment NPD
• Grand Lake Mental Health Center, Inc.

  dba Grand Mental Health

  • Community/Behavioral Health Agency
  • Tulsa, OK
  • NPI 1356048656
  NPD
• Grand Lake Mental Health Center, Inc.

  dba GRAND Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Vinita, OK
  • NPI 1710994835
  NPD

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

{
    "created_epoch": "1533686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1790264026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2526",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648032526",
            "telephone_number": "417-347-7579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 W 30TH ST",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041520",
            "telephone_number": "417-347-7580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPHERD",
        "first_name": "KELLEE",
        "middle_name": "D",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-08",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MO",
            "license": "2018020044",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2018020044",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2021001168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLEE",
            "last_name": "PATTON",
            "middle_name": "D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jonathan A Sheldon Sr., MD
• Sydney Shelfer
• Emma Eileen Shelley
• Brenden Charles Shelton
• Jaclyn R Shepherd
• Vicki M Sherraden
• Charles F Sherrod III, M.D.
• Chloe Aretta Sherwood
• Shield and Haven Therapy LLC
• Marcie M Shields, FNP-C

• Clinical Social Worker in Joplin, MO
• Providers in Joplin, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.