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KERBY KEYLON KILLINGHAM
NPI 1750893210
Counselor - Mental Health in Grand Rapids, MI

Active since October 24, 2017PECOS Enrolled
3940 PENINSULAR DR SE STE 230, GRAND RAPIDS, MI 49546(616) 856-0037 Get Directions Write a Review

NPPES record last updated: August 20, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 20, 2026, Jan 14, 2020, Nov 4, 2019 and 1 more (4 updates tracked since 2017).

About Kerby Keylon Killingham NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KERBY KEYLON KILLINGHAM (NPI 1750893210) is an individual mental health provider in Grand Rapids, Michigan, licensed in Michigan (6401017677) and active in the NPI registry since October 2017. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1750893210
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameKERBY KEYLON KILLINGHAM
Location Address3940 PENINSULAR DR SE STE 230Grand Rapids, MI 49546-6187
Mailing Address3940 Peninsular Dr Se Ste 230Grand Rapids, MI 49546-6187
Phone(616) 856-0037
Sole ProprietorYes
Enumeration DateOctober 24, 2017
Last NPPES UpdateAugust 20, 20264 updates tracked since enumeration
NPPES CertifiedAugust 20, 2026
✔ NPI 1750893210 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in MI · 6401017677
3940 PENINSULAR DR SE STE 230, Grand Rapids, MI 49546
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kerby Keylon Killingham is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FISCHER COUNSELING SERVICES
Counselor
3940 PENINSULAR DR SE STE 230
GRAND RAPIDS, MI 49546
Kent County (616) 227-0815
KP AND ASSOCIATES LLC
Counselor (Mental Health)
3940 PENINSULAR DR SE STE 230
GRAND RAPIDS, MI 49546
Kent County (616) 856-0037
DR. JULIA CUNNINGHAM PETROS PSY.D.
Psychologist (Clinical)
3940 PENINSULAR DR SE STE 230
GRAND RAPIDS, MI 49546
Kent County (616) 458-0692
DR. JENNIFER SCHAAFSMA PHD
Psychologist (Clinical)
3940 PENINSULAR DR SE STE 230
GRAND RAPIDS, MI 49546
Kent County (616) 458-0692
MIWAY HOME CARE
Home Health
3940 PENINSULAR DR SE STE 230
GRAND RAPIDS, MI 49546
Kent County (516) 477-5938

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kerby Killingham's NPI number?

The NPI number for Kerby Killingham is 1750893210. It was assigned to this individual provider in the NPPES registry on October 24, 2017.

Where is Kerby Killingham located?

Kerby Killingham practices at 3940 Peninsular Dr SE Ste 230, Grand Rapids, MI 49546. The listed phone number is (616) 856-0037.

What is Kerby Killingham's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Kerby Killingham enrolled in Medicare?

Yes. Kerby Killingham is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kerby Killingham was last updated on August 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.