Kimberly Kaye Waddell

Primary specialty

Assistant Behavior AnalystTaxonomy code 106E00000X

Practice address

129 E Branch St
Longview, TX 75604-3203

Phone

(903) 445-8303

NPI assigned

Nov 24, 2023

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1700784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700784000000",
    "number": "1194590786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7108 S KANNER HWY",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349977462",
            "telephone_number": "903-445-8303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 E BRANCH ST",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756043203",
            "telephone_number": "903-445-8303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDELL",
        "first_name": "KIMBERLY",
        "middle_name": "KAYE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-24",
        "last_updated": "2023-11-24",
        "certification_date": "2023-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vrai Prosthetic Care P.L.L.C.
• Mark Ziggy Vrana
• Donna Vu
• Wa-Mart Stores Texas, LP
• Gregory Kyle Wacasey, O. D.
• Byron Richard Wadley, MD
• Madison Moore Wagner, FNP-C
• Wal-Mart Stores Texas LLC
• Wal-Mart Stores Texas LLC
• Wal-Mart Stores Texas LLC

• Assistant Behavior Analyst in Longview, TX
• Providers in Longview, TX by specialty
• Assistant Behavior Analyst in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2023; 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.