Active NPI
Kim Mims
- Community Health Worker
- Bridgeport, CT
National Provider Identifier
1215162425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- # HCA.0000365
- Practice address
- 865 Laurel Ave
Bridgeport, CT 06604-2406 - Phone
- (203) 854-6667
- Fax
- (203) 549-8683
- NPI assigned
- May 18, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | # HCA.0000365 | CT | Primary |
Addresses
Primary practice location
865 Laurel Ave
Bridgeport, CT 06604-2406
Mailing address
865 Laurel Ave
Bridgeport, CT 06604-2406
Phone (203) 854-6667
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 |
|---|---|---|---|
| # HCA.0000365 | CT | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242604800000",
"number": "1215162425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "865 LAUREL AVE",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066042406",
"telephone_number": "203-854-6667",
"fax_number": "203-549-8683"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "865 LAUREL AVE",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066042406",
"telephone_number": "203-854-6667",
"fax_number": "203-549-8683"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIMS",
"first_name": "KIM",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-18",
"last_updated": "2009-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "CT",
"license": "# HCA.0000365",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.