Kimberly Dominique McCormick, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

890852 Issued in NY

Practice address

29
Macintosh Drive
Middletown, NY 10941

Phone

(347) 678-3402

NPI assigned

Sep 24, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Kimberly Dominique McCormick Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1124502398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29",
            "address_2": "MACINTOSH DRIVE",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "10941",
            "telephone_number": "347-678-3402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29",
            "address_2": "MACINTOSH DRIVE",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "10941",
            "telephone_number": "347-678-3402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "KIMBERLY",
        "middle_name": "DOMINIQUE",
        "name_prefix": "Ms.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-24",
        "last_updated": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "3327211",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "890852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "MCCORMICK",
            "middle_name": "DOMINIQUE",
            "prefix": "MS.",
            "credential": "RN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Gina M McCann
• Kendall McCarey
• Kristyn McCarthy
• Sandra McCathy
• Fred Allen McCormack, LMSW
• Wendy Marie McCormick
• Frank McDermott, RN
• Ashley McDonald, CRNA
• Katherine Grace McDonald, NP
• Marie McDowell, RN

• Registered Nurse in Middletown, NY
• Providers in Middletown, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; 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.