Kimberly R Self, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

1395 Issued in AK

Practice address

1296 Agvik Street
Barrow, AK 99723-0029

Phone

(907) 852-9221

Fax

(907) 852-9297

NPI assigned

Nov 19, 2009

Last updated

Jul 18, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1258588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342569600000",
    "number": "1073841797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1296 AGVIK STREET",
            "address_2": "PO BOX 29",
            "city": "BARROW",
            "state": "AK",
            "postal_code": "997230029",
            "telephone_number": "907-852-9221",
            "fax_number": "907-852-9297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1296 AGVIK STREET",
            "city": "BARROW",
            "state": "AK",
            "postal_code": "997230029",
            "telephone_number": "907-852-9221",
            "fax_number": "907-852-9297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELF",
        "first_name": "KIMBERLY",
        "middle_name": "R",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-19",
        "last_updated": "2012-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "24630",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AK",
            "license": "1395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Rowe, CDCI
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• Samuel Simmonds Memorial Hospital
• Samuel Simmonds Memorial Hospital
• Jennifer Sharpe, PMHNP-BC
• Robin Shemanski, RN
• Heidi Dawn Shinn, MSPT
• Michael Smalley, LPN
• Claudia Dunn Stickman

• Dentist in Barrow, AK
• Providers in Barrow, AK by specialty
• Dentist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.