Individual
DR. KELLY L. IRVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1000 W NIFONG BLVD BLDG 6, COLUMBIA, MO 65203-5615
(888) 403-1071
Mailing address
1800 COMMUNITY, CLINTON, MO 64735-8804
(660) 890-8156
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
2018042229
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116730
BHN
AZ
05
—
141592
—
LA
01
—
2128566
CIGNA
AZ
01
—
228289
ONE HEALTH & GWL
AZ
01
—
291968
MHN
AZ
01
—
4142
CPQ
—
01
—
415
IA HSP #
IA
01
—
50583
NRHSP IN PSYCH
—
01
—
5457314
FIRST HEALTH/CNN
AZ
05
—
803925
—
AZ
01
—
86-1043861
MAGELAN, BIODYNE, AETNA
AZ
01
—
APA MEMBERSHIP #
69103091
AZ
01
—
AZ0616050
BC/BS
AZ
01
—
NATIONAL REGISTER #
50583
AZ
Enumeration date
11/02/2006
Last updated
08/28/2019
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