Active NPI
Kimberly Charleston, MSCCCSLP
- Contractor
- Philadelphia, PA
National Provider Identifier
1174794754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- SL002343L
- Practice address
- 7051 Passyunk Ave
Philadelphia, PA 19142-1724 - Phone
- (215) 492-1079
- Fax
- (215) 492-1083
- NPI assigned
- Mar 21, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | SL002343L | PA | Primary |
Addresses
Primary practice location
7051 Passyunk Ave
Philadelphia, PA 19142-1724
Mailing address
7051 Passyunk Ave
Philadelphia, PA 19142-1724
Phone (215) 492-1079
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0019719730003 | Medicaid | PA |
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 |
|---|---|---|---|
| SL002343L | PA | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapy Solutions Children'S Services | Past | Accepting new patients | |
| Therapy Solutions, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Early Intervention Provider Agency
- Philadelphia, PA
- NPI 1043409576
-
- Early Intervention Provider Agency
- Philadelphia, PA
- NPI 1174751770
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206057600000",
"number": "1174794754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7051 PASSYUNK AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191421724",
"telephone_number": "215-492-1079",
"fax_number": "215-492-1083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7051 PASSYUNK AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191421724",
"telephone_number": "215-492-1079",
"fax_number": "215-492-1083"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHARLESTON",
"first_name": "KIMBERLY",
"name_prefix": "Ms.",
"credential": "MSCCCSLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-21",
"last_updated": "2008-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "PA",
"license": "SL002343L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0019719730003",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.