Active NPI
Gordan Kelley, LMSW-ACP
- Social Worker
- Ft Worth, TX
National Provider Identifier
1942328588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S00473
- Practice address
- 6387B Camp Bowie Blvd # 156
Ft Worth, TX 76116-5423 - Phone
- (817) 732-4225
- NPI assigned
- Mar 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | S00473 | TX | Primary |
Addresses
Primary practice location
6387B Camp Bowie Blvd # 156
Ft Worth, TX 76116-5423
Mailing address
6387B Camp Bowie Blvd # 156
Ft Worth, TX 76116-5423
Phone (817) 732-4225
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S00473 | TX | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1942328588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6387B CAMP BOWIE BLVD # 156",
"city": "FT WORTH",
"state": "TX",
"postal_code": "761165423",
"telephone_number": "817-732-4225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6387B CAMP BOWIE BLVD # 156",
"city": "FT WORTH",
"state": "TX",
"postal_code": "761165423",
"telephone_number": "817-732-4225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "GORDAN",
"credential": "LMSW-ACP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-26",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TX",
"license": "S00473",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.