DR. KELLY L. IRVINE (NPI# 1134207269) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134207269 |
| Entity Type | Individual |
| Full Name | DR. KELLY L. IRVINE |
| Other Name | DR. KELLY L. MOYNIHAN |
| Credential | PSYD |
| Practice Address |
1000 W Nifong Blvd Bldg 6 Columbia MO 65203-5615 |
| Mailing Address |
1800 Community Clinton MO 64735-8804 |
| Practice Telephone | 8884031071 |
| Mailing Telephone | 6608908156 |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2019-08-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
2018042229 | MO | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | MHN | 291968 | 01 |
| NRHSP IN PSYCH | 50583 | 01 | |
| AZ | BC/BS | AZ0616050 | 01 |
| AZ | FIRST HEALTH/CNN | 5457314 | 01 |
| CPQ | 4142 | 01 | |
| AZ | 803925 | 05 | |
| AZ | BHN | 116730 | 01 |
| AZ | ONE HEALTH & GWL | 228289 | 01 |
| LA | 141592 | 05 | |
| AZ | CIGNA | 2128566 | 01 |
| IA | IA HSP # | 415 | 01 |
| AZ | MAGELAN, BIODYNE, AETNA | 86-1043861 | 01 |
| AZ | 69103091 | APA MEMBERSHIP # | 01 |
| AZ | 50583 | NATIONAL REGISTER # | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558567685 | Kelly Lynn Irvine | Occupational Therapist | 453 Maple St, Grove City, PA 16127-2324 | 2007-06-25 |
| Street Address |
1000 W NIFONG BLVD BLDG 6 |
| City | COLUMBIA |
| State | MO |
| Zip Code | 65203-5615 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487261640 | Neha Simron Batool | Counselor | 1000 W Nifong Blvd Bldg 6, Columbia, MO 65203-5615 | 2020-09-30 |
| 1841852613 | Compass Health, Inc. | Clinic/Center | 1000 W Nifong Blvd Bldg 6, Columbia, MO 65203-5615 | 2019-07-02 |
| 1366720385 | Swarnalatha Reddy Yerrapu | Psychiatry & Neurology | 1000 W Nifong Blvd Bldg 6, Columbia, MO 65203-5615 | 2011-07-25 |
| 1346546132 | Kimberly Lockwood Rust | Social Worker | 1000 W Nifong Blvd Bldg 6, Columbia, MO 65203-5615 | 2011-01-27 |
| 1417273111 | Cosha Peterson | Counselor | 1000 W Nifong Blvd Bldg 6, Columbia, MO 65203-5615 | 2010-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982229498 | Rebecca Wallace Counseling LLC | Clinic/Center | 207 Peach Way, Suite 110, Columbia, MO 65203 | 2020-06-10 |
| 1144797101 | Mary Zhang | Family Medicine | 200 Southampton Drive, Ste 102, Columbia, MO 65203 | 2018-10-29 |
| 1871090258 | Hina Omer Khokhar | Pathology | 4601 Apt F West Millbrook Dr, Columbia, MO 65203 | 2018-04-11 |
| 1154820157 | David Vincent Spencer | Internal Medicine | 201 W Broadway Building, Suite E, Columbia, MO 65203 | 2018-02-05 |
| 1598283103 | Donna Strickland | Counselor | 201 W Broadway Bldg 2, Suite F, Columbia, MO 65203 | 2017-09-03 |
| 1134643182 | Anna Kathryn Christensen | Physician Assistant | 4107 Baurichter Dr., Columbia, MO 65203 | 2017-08-01 |
| 1558885871 | Juan Camilo Pineda | Internal Medicine | 210 Portland Street Suite 104, Columbia, MO 65203 | 2017-07-28 |
| 1922530096 | The Missing L Inc | Community/Behavioral Health | 3605 S. Providence Rd, Suite 6, Columbia, MO 65203 | 2017-03-29 |
| 1689118010 | Linda Landry | Nurse Practitioner | 1000 W. Nifong, Bldg 2 Suite 150, Columbia, MO 65203 | 2016-12-04 |
| 1417313552 | Brittany Lea Ramirez | Chiropractor | 2001 Corona Rd Ste 205, Columbia, MO 65203 | 2016-01-05 |
| Find all providers in zip 65203 | ||||
| Taxonomy Code | 103TB0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Cognitive & Behavioral |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710434816 | Latanya Long | Psychologist | 8970 Route 108 Ste B, Columbia, MD 21045-2145 | 2016-09-06 |
| 1770948457 | Lorraine Tavarez Lopez | Psychologist | 1 Windsor Cv Ste 404, Columbia, SC 29223-1833 | 2015-12-22 |
| 1376847483 | Susan Kreh Beck | Psychologist | 304 Firebridge Rd, Columbia, SC 29223-5122 | 2011-01-04 |
| 1548429640 | Elspeth Neiman Bell | Psychologist | 5850 Waterloo Rd, Suite 140, Columbia, MD 21045-1941 | 2008-06-03 |
| 1760601181 | Jeanne M. Bolton | Psychologist | 7270 Cradlerock Way, Columbia, MD 21045-5025 | 2007-04-24 |
| 1689118358 | Valerie Hooper | Psychologist | 3501 Berrywood Dr, Columbia, MO 65201-6584 | 2016-12-14 |
| 1558793729 | Sterling P. Watson | Psychologist | 2611 River Dr, Columbia, SC 29201-1749 | 2013-07-30 |
| 1659716272 | Lucy R. Leibowitz | Psychologist | 8821 Columbia 100 Parkway, Columbia, MD 21045 | 2013-05-09 |
| 1225308448 | Thelvanesa Murphy | Psychologist | 4824 Smallwood Rd, Unit 202, Columbia, SC 29223-3232 | 2012-01-04 |
| 1023295235 | Jacqueline Shoshannah Iseman | Psychologist | 10796 Hickory Ridge Rd, Columbia, MD 21044-3646 | 2008-01-30 |
| Find all providers in COLUMBIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.