Individual provider Active NPI

Keri Jean Mims, MA

  • Professional Counselor
  • Cartersville, GA
National Provider Identifier
1114422805
Registry record updated Mar 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Practice address
650 Henderson Dr Ste 202
Cartersville, GA 30120-3723
Phone
(770) 334-2493
NPI assigned
Mar 26, 2018
Last updated
Mar 26, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X NU Primary

Addresses

Primary practice location

650 Henderson Dr Ste 202
Cartersville, GA 30120-3723

Mailing address

1524 Davis Farm Dr NW
Kennesaw, GA 30152-7844

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
Credentials
Master of Arts

NPI Registry JSON

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522022400000",
    "number": "1114422805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1524 DAVIS FARM DR NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301527844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 HENDERSON DR STE 202",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301203723",
            "telephone_number": "770-334-2493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIMS",
        "first_name": "KERI",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-26",
        "last_updated": "2018-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cartersville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.

Verify at the official NPI Registry.