Mary Kathleen Kelley, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0558C Issued in AL

Practice address

600 Sun Temple Dr
Madison, AL 35758-8643

Phone

(256) 975-4291

NPI assigned

Sep 27, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

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, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Russellville Hospital Inc.Group PAC ID 3476878489, 66 clinicians

Integrated Behavioral Health IncGroup PAC ID 7416194113, 109 clinicians

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 and National Provider Directory roles.

• Integrated Behavioral Health, Inc.

  • Psychiatry Physician
  • Madison, AL
  • NPI 1730522699

  Clinical

  Medicare reassignment Care Compare group NPD
• Russellville Hospital Inc

  • Family Medicine Physician
  • Russellville, AL
  • NPI 1780232314
  Medicare reassignment Care Compare group NPD
• Russellville Hospital Inc

  • Rural Health Clinic/Center
  • Russellville, AL
  • NPI 1508491093
  NPD

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

{
    "created_epoch": "1664236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664236800000",
    "number": "1972227783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 SUN TEMPLE DR",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357588643",
            "telephone_number": "256-975-4291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 SUN TEMPLE DR",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357588643",
            "telephone_number": "256-975-4291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "MARY",
        "middle_name": "KATHLEEN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-27",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AL",
            "license": "0558C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katy Frazier Pmhnp BC LLC
• Alex Louis Kearns
• Wendy Allison Keeler, M.A., CCC-SLP
• Sierra Keith, MSN, CRNP, FNP-C
• Heather Nicole Kelley, FNP
• Joy M Kello, FNP-C
• Anna Catherine Kelly, CRNP
• Chadwick Michael Kemp, NP-C
• Brittney Adams Kendrick, CRNP
• Theresa Paige Kennedy, O.D.

• Clinical Social Worker in Madison, AL
• Providers in Madison, AL by specialty
• Clinical Social Worker in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; 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.