Active NPI
Shawna Blake Kirby, PHD
- Clinical Neuropsychologist
- West Columbia, SC
National Provider Identifier
1174686356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 1251
- Practice address
- 1505 Charleston Hwy
# 1523
West Columbia, SC 29169-5069 - Phone
- (803) 497-3640
- Fax
- (888) 352-7678
- NPI assigned
- Dec 18, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1251 | SC | |
| Clinical Neuropsychologist | 103G00000X | 1251 | SC | Primary |
Addresses
Primary practice location
1505 Charleston Hwy
# 1523
West Columbia, SC 29169-5069
Mailing address
1505 Charleston Hwy
# 1523
West Columbia, SC 29169-5069
Phone (803) 995-1838
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PS0613 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC, ME
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midlands Neurobehavioral Services, LLC | Clinical Neuropsychologist | Current | Accepting new patients |
Locations
1705 Richland St
Columbia, SC 29201
Phone (803) 995-1838
1505 Charleston Hwy
#1523
West Columbia, SC 29169
Phone (803) 497-3640
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709078400000",
"number": "1174686356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1505 CHARLESTON HWY",
"address_2": "# 1523",
"city": "WEST COLUMBIA",
"state": "SC",
"postal_code": "291695069",
"telephone_number": "803-995-1838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1505 CHARLESTON HWY",
"address_2": "# 1523",
"city": "WEST COLUMBIA",
"state": "SC",
"postal_code": "291695069",
"telephone_number": "803-497-3640",
"fax_number": "888-352-7678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRBY",
"first_name": "SHAWNA",
"middle_name": "BLAKE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-18",
"last_updated": "2024-02-28",
"certification_date": "2024-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "SC",
"license": "1251",
"primary": false
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "SC",
"license": "1251",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PS0613",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.