Active NPI
Nedra Fetterman, PH.D.
- Clinical Psychologist
- Ardmore, PA
National Provider Identifier
1942537337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS006250L
- Practice address
- 119 Coulter Ave
Suite 202
Ardmore, PA 19003-2427 - Phone
- (610) 896-0800
- NPI assigned
- Nov 6, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS006250L | PA | Primary |
Addresses
Primary practice location
119 Coulter Ave
Suite 202
Ardmore, PA 19003-2427
Mailing address
119 Coulter Ave
Suite 202
Ardmore, PA 19003-2427
Phone (610) 896-0800
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS006250L | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257465600000",
"number": "1942537337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "119 COULTER AVE",
"address_2": "SUITE 202",
"city": "ARDMORE",
"state": "PA",
"postal_code": "190032427",
"telephone_number": "610-896-0800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 COULTER AVE",
"address_2": "SUITE 202",
"city": "ARDMORE",
"state": "PA",
"postal_code": "190032427",
"telephone_number": "610-896-0800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETTERMAN",
"first_name": "NEDRA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-11-06",
"last_updated": "2009-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS006250L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ardmore, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.