Active NPI
Kimberly Clanton
- Speech-Language Pathologist
- Portland, TX
National Provider Identifier
1013685064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 108249
- Practice address
- 1140 Broadway Blvd
Portland, TX 78374-4235 - Phone
- (361) 777-4255
- NPI assigned
- Sep 3, 2021
- Last updated
- Sep 3, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 108249 | TX | Primary |
Addresses
Primary practice location
1140 Broadway Blvd
Portland, TX 78374-4235
Mailing address
1140 Broadway Blvd
Portland, TX 78374-4235
Phone (361) 777-4255
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108249 | TX | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630627200000",
"number": "1013685064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1140 BROADWAY BLVD",
"city": "PORTLAND",
"state": "TX",
"postal_code": "783744235",
"telephone_number": "361-777-4255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1140 BROADWAY BLVD",
"city": "PORTLAND",
"state": "TX",
"postal_code": "783744235",
"telephone_number": "361-777-4255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLANTON",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-03",
"last_updated": "2021-09-03",
"certification_date": "2021-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "108249",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, TX
- Jesus Cervantes, PTA
- Haidee Chapa, PTA
- Charles Gregory, DO PA
- Galo Efrain Chaves, R.PH.
- Christ Centered Counseling Services PLLC
- Coastal Bend Physicians PLLC
- Coastal ER III, LLC (Physicians Premier Emergency Room)
- Coastal Health Diagnostics Laboratory LLC
- Coastal Plains Community MHMR Center (Coastal Plains Community Center)
- Coastal Plains Community MHMR Center (Coastal Plains Community Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.