Active NPI
Christine Leigh Kmiecik
- Clinical Social Worker
- Scott Air Force Base, IL
National Provider Identifier
1053684712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 310 W Losey St
Scott Air Force Base, IL 62225-5250 - Phone
- (618) 256-9355
- NPI assigned
- Feb 10, 2012
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
310 W Losey St
Scott Air Force Base, IL 62225-5250
Mailing address
310 W Losey St
Scott Air Force Base, IL 62225-5250
Phone (618) 256-9355
Other practice location 1
1100 Wilford Hall Loop Bldg 4554
San Antonio, TX 78236-5638
Phone (210) 292-4468
Other practice location 2
3 Saint Elizabeth Blvd Ste 4000
O Fallon, IL 62269-1284
Phone (618) 222-4600
Other practice location 3
18th Medical Group
Unit 5142
Apo, AP 96368-5142
Phone (815) 247-8700
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": "1328832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754265600000",
"number": "1053684712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 W LOSEY ST",
"city": "SCOTT AIR FORCE BASE",
"state": "IL",
"postal_code": "622255250",
"telephone_number": "618-256-9355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 W LOSEY ST",
"city": "SCOTT AIR FORCE BASE",
"state": "IL",
"postal_code": "622255250",
"telephone_number": "618-256-9355"
}
],
"practiceLocations": [
{
"address_1": "1100 Wilford Hall Loop Bldg 4554",
"address_purpose": "LOCATION",
"city": "San Antonio",
"state": "TX",
"postal_code": "782365638",
"country_code": "US",
"telephone_number": "210-292-4468",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3 Saint Elizabeth Blvd Ste 4000",
"address_purpose": "LOCATION",
"city": "O Fallon",
"state": "IL",
"postal_code": "622691284",
"country_code": "US",
"telephone_number": "618-222-4600",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "18th Medical Group",
"address_2": "Unit 5142",
"address_purpose": "LOCATION",
"city": "APO",
"state": "AP",
"postal_code": "963685142",
"country_code": "US",
"telephone_number": "815-247-8700",
"country_name": "United States",
"address_type": "MIL"
}
],
"basic": {
"last_name": "KMIECIK",
"first_name": "CHRISTINE",
"middle_name": "LEIGH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-02-10",
"last_updated": "2025-08-04",
"certification_date": "2025-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scott Air Force Base, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.