Active NPI
Kimberly Renee' Carroll-Bevly, CNA
- In Home Supportive Care Agency
- Saint Louis, MO
National Provider Identifier
1023624871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- In Home Supportive Care Agency
- Practice address
- 3120 Wyoming St
Saint Louis, MO 63118-2130 - Phone
- (313) 297-6141
- NPI assigned
- Sep 17, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | |||
| In Home Supportive Care Agency | 253Z00000X | Primary |
Addresses
Primary practice location
3120 Wyoming St
Saint Louis, MO 63118-2130
Mailing address
3120 Wyoming St
Saint Louis, MO 63118-2130
Phone (314) 297-6141
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600300800000",
"number": "1023624871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3120 WYOMING ST",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631182130",
"telephone_number": "314-297-6141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3120 WYOMING ST",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631182130",
"telephone_number": "313-297-6141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL-BEVLY",
"first_name": "KIMBERLY",
"middle_name": "RENEE'",
"name_prefix": "Mrs.",
"credential": "CNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-17",
"last_updated": "2020-09-17",
"certification_date": "2020-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "253Z00000X",
"taxonomy_group": "",
"desc": "In Home Supportive Care",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.