Active NPI
Kelly K Frederick
- School Psychologist
- Warren, IN
National Provider Identifier
1821652876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 10267664
- Practice address
- 1063 E 900 S
Warren, IN 46792-9214 - Phone
- (260) 468-3093
- NPI assigned
- Apr 25, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| 10267664 | IN | MD | School Psychologist |
| RBT-19-78150 | IN | MD | Behavior Technician |
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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 10267664 | IN | Primary |
| Behavior Technician | 106S00000X | RBT-19-78150 | IN |
Addresses
Primary practice location
1063 E 900 S
Warren, IN 46792-9214
Mailing address
1063 E 900 S
Warren, IN 46792-9214
Phone (260) 468-3093
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10267664 | Other | IN | INDIANA DEPARTMENT OF EDUCATION |
NPI Registry JSON
{
"created_epoch": "1556150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629331200000",
"number": "1821652876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1063 E 900 S",
"city": "WARREN",
"state": "IN",
"postal_code": "467929214",
"telephone_number": "260-468-3093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1063 E 900 S",
"city": "WARREN",
"state": "IN",
"postal_code": "467929214",
"telephone_number": "260-468-3093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICK",
"first_name": "KELLY",
"middle_name": "K",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-25",
"last_updated": "2021-08-19",
"certification_date": "2021-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "IN",
"license": "10267664",
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IN",
"license": "RBT-19-78150",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIANA DEPARTMENT OF EDUCATION",
"identifier": "10267664",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Warren, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.