Karri J Coburn-Clark, MA
Individual provider Active NPI Psychologist · Frankfort, KY
NPI 1851449219 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1851449219
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 1592 (KY)
- Practice address
- 111 Doctors Drive
Frankfort, KY 40601-9393 - Phone
- (859) 253-1686
- Fax
- (859) 254-2743
- NPI assigned
- Jan 8, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1592 | KY | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Vista of the Bluegrass Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1592 | KY | Yes |
Addresses
Primary practice location
111 Doctors Drive
Frankfort, KY 40601-9393
Mailing address
1351 Newtown Pike
Lexington, KY 40511-1217
Phone (859) 253-1686
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30615058 | Medicaid | KY |
Other providers in Frankfort, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.