Active NPI
Destenee Kimi-Taylor Pham
- Occupational Therapist
- Bristol, TN
National Provider Identifier
1154025534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 24083
- Practice address
- 501 Martindale Rd
Bristol, TN 37620-6152 - Phone
- (423) 340-1471
- NPI assigned
- Mar 29, 2023
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 24083 | FL | Primary |
Addresses
Primary practice location
501 Martindale Rd
Bristol, TN 37620-6152
Mailing address
1091 Embreville Rd
Johnson City, TN 37604-7046
Phone (423) 340-1471
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 |
|---|---|---|---|
| 24083 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739232000000",
"number": "1154025534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1091 EMBREVILLE RD",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376047046",
"telephone_number": "423-340-1471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 MARTINDALE RD",
"city": "BRISTOL",
"state": "TN",
"postal_code": "376206152",
"telephone_number": "423-340-1471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "DESTENEE",
"middle_name": "KIMI-TAYLOR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-29",
"last_updated": "2025-02-11",
"certification_date": "2025-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "24083",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bristol, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.