Active NPI
Kimberly Bultema
- Speech-Language Pathologist
- Wilton, ND
National Provider Identifier
1053702290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 1106
- Practice address
- 504 Dakota Ave
Wilton, ND 58579-7113 - Phone
- (701) 734-6559
- NPI assigned
- Feb 10, 2015
- 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 | 1106 | ND | Primary |
Addresses
Primary practice location
504 Dakota Ave
Wilton, ND 58579-7113
Mailing address
215 2ND St SE
Minot, ND 58701-3924
Phone (701) 857-4411
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 |
|---|---|---|---|
| 1106 | ND | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423526400000",
"number": "1053702290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 2ND ST SE",
"city": "MINOT",
"state": "ND",
"postal_code": "587013924",
"telephone_number": "701-857-4411",
"fax_number": "701-857-4413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "504 DAKOTA AVE",
"city": "WILTON",
"state": "ND",
"postal_code": "585797113",
"telephone_number": "701-734-6559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULTEMA",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-10",
"last_updated": "2015-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ND",
"license": "1106",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilton, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.