Active NPI
Carolyn Darlene Kelley, CRADC
- Addiction (Substance Use Disorder) Counselor
- Cape Girardeau, MO
National Provider Identifier
1831653252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 2708
- Practice address
- 760 S Kingshighway St
Cape Girardeau, MO 63703-7630 - Phone
- (573) 335-4333
- Fax
- (573) 335-4345
- NPI assigned
- Jan 30, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 2708 | MO | Primary |
Addresses
Primary practice location
760 S Kingshighway St
Cape Girardeau, MO 63703-7630
Mailing address
760 S Kingshighway St
Cape Girardeau, MO 63703-7630
Phone (573) 335-4333
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 |
|---|---|---|---|
| 2708 | MO | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548806400000",
"number": "1831653252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "760 S KINGSHIGHWAY ST",
"city": "CAPE GIRARDEAU",
"state": "MO",
"postal_code": "637037630",
"telephone_number": "573-335-4333",
"fax_number": "573-335-4345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "760 S KINGSHIGHWAY ST",
"city": "CAPE GIRARDEAU",
"state": "MO",
"postal_code": "637037630",
"telephone_number": "573-335-4333",
"fax_number": "573-335-4345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "CAROLYN",
"middle_name": "DARLENE",
"name_prefix": "Mrs.",
"credential": "CRADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-30",
"last_updated": "2019-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MO",
"license": "2708",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cape Girardeau, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.