Kimberly Ann Callaway Gentry, PHD
Individual provider Active NPI Psychologist · Conway, AR
NPI 1073137253 · NPPES record last updated Jan 25, 2023
Key facts
- NPI
- 1073137253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 202217 (AR)
- Practice address
- 317 Oak St Ste 3
Conway, AR 72032-5679 - Phone
- (501) 358-6396
- NPI assigned
- Jun 3, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220512001713 | AR | Practitioner - Clinical Psychologist | 3577940568 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 202217 | AR | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapy Assessment Center, LLC | Psychologist | Current |
Accepting new patients |
| Therapy Assessment Center LLC | Current |
Accepting new patients | |
| Arkansas Families First LLC | Past |
Accepting new patients | |
| Pediatrics Plus Counseling & Diagnostics LLC | Past | Accepting new patients |
Locations
317 Oak St
Ste 3
Conway, AR 72032
Phone (501) 291-3091
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 202217 | AR | Yes |
Addresses
Primary practice location
317 Oak St Ste 3
Conway, AR 72032-5679
Mailing address
23 Colt Loop
Greenbrier, AR 72058-9197
Phone (501) 581-0352
Other practice location 1
19 Business Park Dr Ste 5
Greenbrier, AR 72058-9286
Phone (501) 581-7703
Other names
- Dr. Kim Gentry
Other providers in Conway, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.