Kimberly Tersilla Smith, AUD

Primary specialty

AudiologistTaxonomy code 231H00000X

License

AU3301 Issued in CA

Practice address

10200 Trinity Pkwy Ste 201
Stockton, CA 95219-7288

Phone

(209) 952-0483

Fax

(209) 478-5785

NPI assigned

May 29, 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

Other names 1

• Kimberly Tersilla Ledda Former name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Regents of the University of California

  dba UC Davis Medical Group

  • Multi-Specialty Clinic/Center
  • Sacramento, CA
  • NPI 1952998973
  Medicare reassignment NPD
• Regents of the University of California

  dba UC Davis Medical Group

  • Multi-Specialty Clinic/Center
  • Rocklin, CA
  • NPI 1518947167
  NPD

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

{
    "created_epoch": "1527552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589414400000",
    "number": "1023509734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 EXPOSITION BLVD BLDG 700",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958154314",
            "telephone_number": "916-736-3399",
            "fax_number": "916-233-4171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10200 TRINITY PKWY STE 201",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952197288",
            "telephone_number": "209-952-0483",
            "fax_number": "209-478-5785"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 Exposition Blvd Bldg 700",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958154314",
            "country_code": "US",
            "telephone_number": "916-736-3399 x1082",
            "fax_number": "916-233-4171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KIMBERLY",
        "middle_name": "TERSILLA",
        "name_prefix": "Ms.",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-29",
        "last_updated": "2020-05-14",
        "certification_date": "2020-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "CA",
            "license": "AU3301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "LEDDA",
            "middle_name": "TERSILLA",
            "credential": "AUD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeremy Smith
• Jerris Lynn Smith
• Jerry Dupree Smith
• Joseph Eugene Smith III
• Kaitlend Tatiana Smith, B.A.
• Mark Angelo Smith
• Michael William Smith, M.D.
• Morgan Tyrone Smith
• Nick E Smith, D.D.S.
• Oceana Smith

• Audiologist in Stockton, CA
• Providers in Stockton, CA by specialty
• Audiologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.