Active NPI
Rickendra Kelley, SWT
- Social Worker
- Dayton, OH
National Provider Identifier
1861030728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S.2001302-TRNE
- Practice address
- 601 S Edwin C Moses Blvd
Dayton, OH 45417-3424 - Phone
- (937) 734-8333
- NPI assigned
- Dec 11, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S.2001302-TRNE | OH | Primary |
| Case Manager/Care Coordinator | 171M00000X | OH |
Addresses
Primary practice location
601 S Edwin C Moses Blvd
Dayton, OH 45417-3424
Mailing address
601 S Edwin C Moses Blvd
Dayton, OH 45417-3424
Phone (937) 734-8333
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 |
|---|---|---|---|
| S.2001302-TRNE | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1576022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585612800000",
"number": "1861030728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 S EDWIN C MOSES BLVD",
"city": "DAYTON",
"state": "OH",
"postal_code": "454173424",
"telephone_number": "937-734-8333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 S EDWIN C MOSES BLVD",
"city": "DAYTON",
"state": "OH",
"postal_code": "454173424",
"telephone_number": "937-734-8333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "RICKENDRA",
"credential": "SWT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-11",
"last_updated": "2020-03-31",
"certification_date": "2020-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.2001302-TRNE",
"primary": true
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "OH",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.