Kaylee Kimmel Sisson

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2022029693 Issued in MO

Practice address

2673 E Sawyer Rd
Republic, MO 65738-7574

Phone

(417) 324-7646

NPI assigned

Jul 28, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Dynamic Strides Therapy Inc

  • Physical Therapist
  • Republic, MO
  • NPI 1104378561
  Medicare reassignment

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

{
    "created_epoch": "1658966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1194451427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4537 E PEARSON MEADOW DR",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658026242",
            "telephone_number": "417-849-0302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2673 E SAWYER RD",
            "city": "REPUBLIC",
            "state": "MO",
            "postal_code": "657387574",
            "telephone_number": "417-324-7646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISSON",
        "first_name": "KAYLEE",
        "middle_name": "KIMMEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-28",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2022029693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Shields, MS, CF-SLP
• Hannah Shoemaker, COTA
• Rebekah T Sigafus, COTA/L
• Simply Smiles Family Dental, LLC
• Simply Smiles Family Dental, Richard Alvarez, DDS, LLC
• Vickie Sue Smeya, PLPC
• Smith Management Services, LLC
• Brawn Dewayne Smith, DPT
• Velina L Snowden
• Pamela S Stafford

• Speech-Language Pathologist in Republic, MO
• Providers in Republic, MO by specialty
• Speech-Language Pathologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.