Kelly Kendra Wilson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8293-C Issued in AR

Practice address

3162 W Martin Luther King Blvd Ste 13-14
Fayetteville, AR 72704-7679

Phone

(479) 935-4834

NPI assigned

Feb 16, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kelly White Former name

Medicare fee-for-service enrollment

Enrolled in AR

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

Specialty

Clinical Social Worker

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

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.

• Bella Vista Counseling

  • Clinical Social Worker
  • Bella Vista, AR
  • NPI 1053146092
  Medicare reassignment NPD Authorized official
• PT Concepts, PLLC

  dba Waters Edge Counseling Play Therapy and Training

  • Mental Health Counselor
  • Rogers, AR
  • NPI 1164931291
  Medicare reassignment NPD
• My Therapy LLC

  • Mental Health Counselor
  • Rogers, AR
  • NPI 1598633091
  NPD (past)
• St. Francis House Nwa, Inc.

  dba Community Clinic Springdale Medical

  • Federally Qualified Health Center (FQHC)
  • Springdale, AR
  • NPI 1699785089
  NPD (past)
• St. Francis House Nwa, Inc.

  dba Community Clinic Rogers Medical

  • Federally Qualified Health Center (FQHC)
  • Rogers, AR
  • NPI 1710160098
  NPD (past)

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

{
    "created_epoch": "1487203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1902345416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 E EMMA AVE STE 300",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727644469",
            "telephone_number": "479-751-7417",
            "fax_number": "479-751-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3162 W MARTIN LUTHER KING BLVD STE 13-14",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727047679",
            "telephone_number": "479-935-4834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KELLY",
        "middle_name": "KENDRA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-16",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "8293-M",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "8293-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "WHITE",
            "credential": "LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Katie Willis
• Joseph Willmuth
• Morgan E Willoughby
• Catherine Kelley Wilmoth, RD,LD
• Amanda Wilson, RN
• Kendra Solon Wilson, PHARMD
• Kristin Noelle Wilson, OTR/L
• Megan Landry Wilson, PT
• Michael R Wilson, M.D.
• Nathan Wilson, QBHP

• Clinical Social Worker in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.