Individual provider Active NPI

Kimberlyann Marsden, PH.D.

  • Clinical Psychologist
  • Fernandina Beach, FL
National Provider Identifier
1184295339
Registry record updated Jul 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
10992 Issued in FL
Practice address
991 Ocean Bluff Dr
Fernandina Beach, FL 32034-2297
Phone
(904) 844-2344
NPI assigned
Jul 8, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 10992 FL Primary

Addresses

Primary practice location

991 Ocean Bluff Dr
Fernandina Beach, FL 32034-2297

Mailing address

991 Ocean Bluff Dr
Fernandina Beach, FL 32034-2297
Phone (904) 844-2344

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

LicenseStateTypeSpecialty
10992FLMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1625702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625702400000",
    "number": "1184295339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "991 OCEAN BLUFF DR",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320342297",
            "telephone_number": "904-844-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "991 OCEAN BLUFF DR",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320342297",
            "telephone_number": "904-844-2344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSDEN",
        "first_name": "KIMBERLYANN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-08",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "10992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fernandina Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2021; 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.