Individual provider Active NPI

Kelly Horton, PSY.D.

  • Clinical Psychologist
  • Newark, CA
National Provider Identifier
1902813389
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY20970 Issued in CA
Practice address
39675 Cedar Blvd
Suite 240
Newark, CA 94560-5489
Phone
(510) 449-3545
NPI assigned
Aug 1, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY20970 CA Primary

Addresses

Primary practice location

39675 Cedar Blvd
Suite 240
Newark, CA 94560-5489

Mailing address

PO Box 888
Vallejo, CA 94590-0088
Phone (510) 449-3545

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20060921000190 CA Practitioner - Clinical Psychologist 6709881972 Practice locations: Vallejo, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

631 Tennesse St
Vallejo, CA 94590-4432
Phone (707) 362-0456

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY20970CAMDClinical Psychologist
20970CAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kelly Horton, Psy.D. PastSince Jan 1, 1990 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902813389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 888",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945900088",
            "telephone_number": "510-449-3545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39675 CEDAR BLVD",
            "address_2": "SUITE 240",
            "city": "NEWARK",
            "state": "CA",
            "postal_code": "945605489",
            "telephone_number": "510-449-3545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HORTON",
        "first_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY20970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, CA

Sources for this page

Verify at the official NPI Registry.