Active NPI
Kimberly Evans, PH.D.
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1164446480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 13781
- Practice address
- 425 W Beech St Unit 1201
San Diego, CA 92101-2961 - Phone
- (917) 721-0757
- NPI assigned
- Jul 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY31655 | CA | |
| Clinical Psychologist | 103TC0700X | 13781 | NY | Primary |
Addresses
Primary practice location
425 W Beech St Unit 1201
San Diego, CA 92101-2961
Mailing address
425 W Beech St Unit 1201
San Diego, CA 92101-2961
Phone (917) 721-0757
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02006462 | Medicaid | NY |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY31655 | CA | MD | Clinical Psychologist |
| 13781 | NY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinical Psychassociates LLP | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Psychologist
- New York, NY
- NPI 1124051925
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606262400000",
"number": "1164446480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "425 W BEECH ST UNIT 1201",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921012961",
"telephone_number": "917-721-0757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 W BEECH ST UNIT 1201",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921012961",
"telephone_number": "917-721-0757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "KIMBERLY",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-27",
"last_updated": "2020-11-25",
"certification_date": "2020-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY31655",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "13781",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02006462",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.