Active NPI
Kimberly R Ellis, LAC
- Counselor
- Hot Springs, AR
National Provider Identifier
1104066299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- A0909102
- Practice address
- 307 Carpenter Dam Rd Ste B
Hot Springs, AR 71901-8282 - Phone
- (501) 781-2230
- Fax
- (888) 816-7916
- NPI assigned
- Mar 2, 2009
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | A0909102 | AR | Primary |
Addresses
Primary practice location
307 Carpenter Dam Rd Ste B
Hot Springs, AR 71901-8282
Mailing address
201 S Rose St
Sheridan, AR 72150-2451
Phone (870) 917-2171
Other practice location 1
201 S Rose St
Sheridan, AR 72150-2451
Phone (870) 917-2171
Other names 1
- Kimberly R Daugherty
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 |
|---|---|---|---|
| A0909102 | AR | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| BHC Pinnacle Pointe Hospital | Past | Accepting new patients | |
| Chenal Family Therapy, PLC | Past | Accepting new patients | |
| BHC Pinnacle Pointe Hospital LLC | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531958400000",
"number": "1104066299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 S ROSE ST",
"city": "SHERIDAN",
"state": "AR",
"postal_code": "721502451",
"telephone_number": "870-917-2171",
"fax_number": "870-917-2161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 CARPENTER DAM RD STE B",
"city": "HOT SPRINGS",
"state": "AR",
"postal_code": "719018282",
"telephone_number": "501-781-2230",
"fax_number": "888-816-7916"
}
],
"practiceLocations": [
{
"address_1": "201 S Rose St",
"address_purpose": "LOCATION",
"city": "Sheridan",
"state": "AR",
"postal_code": "721502451",
"country_code": "US",
"telephone_number": "870-917-2171",
"fax_number": "870-917-2161",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ELLIS",
"first_name": "KIMBERLY",
"middle_name": "R",
"credential": "LAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-02",
"last_updated": "2018-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "AR",
"license": "A0909102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KIMBERLY",
"last_name": "DAUGHERTY",
"middle_name": "R",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Hot Springs, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.