Kimberly Ann Sandusky

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

000081 Issued in GU

Practice address

1853 Oconnell Blvd
BLDG 1056
Fort Carson, CO 80913-4055

Phone

(719) 526-6748

NPI assigned

Jan 24, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1295827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295827200000",
    "number": "1144525197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 BAYFIELD WAY",
            "address_2": "#201",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809064627",
            "telephone_number": "719-357-3072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1853 OCONNELL BLVD",
            "address_2": "BLDG 1056",
            "city": "FORT CARSON",
            "state": "CO",
            "postal_code": "809134055",
            "telephone_number": "719-526-6748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDUSKY",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-24",
        "last_updated": "2011-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GU",
            "license": "000081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darryl William Sandberg, PA-C
• Chad Sander, DO
• Jasmine Sanders, LCSW
• Nolan Thomas Sanders, DMD
• Tiffany Danielle Sanders, DENTAL ASSISTANT
• Luis Santiago, PA-C
• John S Saur, M.D.
• John Agustus Savage
• Nelson A Sawyer, PA-C
• David C Schaefer, D.M.D.

• Clinical Social Worker in Fort Carson, CO
• Providers in Fort Carson, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; 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.