Active NPI
Kimberly Jimenez
- Behavior Analyst
- Salt Lake City, UT
National Provider Identifier
1063978856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 12987682-2506
- Practice address
- 515 S 700 E Ste 2a
Salt Lake City, UT 84102 - Phone
- (801) 935-4171
- Fax
- (801) 935-4946
- NPI assigned
- Feb 16, 2019
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | |||
| Behavior Technician | 106S00000X | |||
| Behavior Analyst | 103K00000X | 12987682-2506 | UT | Primary |
Addresses
Primary practice location
515 S 700 E Ste 2a
Salt Lake City, UT 84102
Mailing address
515 S 700 E Ste 2a
Salt Lake City, UT 84102-2855
Phone (801) 935-4171
Other practice location 1
713 W Commonwealth Ave Ste C
Fullerton, CA 92832-1612
Phone (714) 879-4274
Other practice location 2
713 W Commonwealth Ave Ste C
Fullerton, CA 92832-1612
Phone (714) 879-4274
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 |
|---|---|---|---|
| 12987682-2506 | UT | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660608000000",
"number": "1063978856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "515 S 700 E STE 2A",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841022855",
"telephone_number": "801-935-4171",
"fax_number": "801-935-4946"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 S 700 E STE 2A",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "84102",
"telephone_number": "801-935-4171",
"fax_number": "801-935-4946"
}
],
"practiceLocations": [
{
"address_1": "713 W Commonwealth Ave Ste C",
"address_purpose": "LOCATION",
"city": "Fullerton",
"state": "CA",
"postal_code": "928321612",
"country_code": "US",
"telephone_number": "714-879-4274",
"fax_number": "714-879-2274",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "713 W Commonwealth Ave Ste C",
"address_purpose": "LOCATION",
"city": "Fullerton",
"state": "CA",
"postal_code": "928321612",
"country_code": "US",
"telephone_number": "714-879-4274",
"fax_number": "714-879-2274",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JIMENEZ",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-16",
"last_updated": "2022-08-16",
"certification_date": "2022-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "UT",
"license": "12987682-2506",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.