Kimberly Bridzeke Staton, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP138337 Issued in TX

Practice address

1201 E 7TH St Ste 620
Austin, TX 78702-3222

Phone

(800) 370-3651

Fax

(877) 515-7147

NPI assigned

Aug 16, 2018

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1534377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534377600000",
    "number": "1003396391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 HATCHETTS HILL RD",
            "city": "OLD LYME",
            "state": "CT",
            "postal_code": "063711534",
            "telephone_number": "800-370-3651",
            "fax_number": "877-515-7147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 E 7TH ST STE 620",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787023222",
            "telephone_number": "800-370-3651",
            "fax_number": "877-515-7147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATON",
        "first_name": "KIMBERLY",
        "middle_name": "BRIDZEKE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-16",
        "last_updated": "2018-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP138337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• State of Texas, Dept. of Aging & Disability, Hcssa
• Takara Monique Staten
• States Become Traits
• Stateserv Medical of Texas
• Judith Ann Stathos, RMT
• Jennifer C Staudenmyer, PT
• Kori Stauffacher, MA, LPC
• Nicole Christine Stavinoha-Pettit, P.T.
• Donna Stavinoha, PT
• Shannon L. Stavinoha, PH.D.

• Psychiatric/Mental Health Nurse Practitioner in Austin, TX
• Providers in Austin, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.