Active NPI
Kimberly Kay Robertson
- Addiction (Substance Use Disorder) Registered Nurse
- Massillon, OH
National Provider Identifier
1215499736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Registered Nurse
- License
- RN365297
- Practice address
- 1660 Nave Rd SE
Massillon, OH 44646-9604 - Phone
- (330) 837-9411
- Fax
- (330) 837-4603
- NPI assigned
- Apr 3, 2019
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Registered Nurse | 163WA0400X | RN365297 | OH | Primary |
Addresses
Primary practice location
1660 Nave Rd SE
Massillon, OH 44646-9604
Mailing address
625 Cleveland Ave NW
Canton, OH 44702-1805
Phone (330) 455-0374
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 |
|---|---|---|---|
| RN365297 | OH | MD | Addiction (Substance Use Disorder) Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554249600000",
"number": "1215499736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 CLEVELAND AVE NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447021805",
"telephone_number": "330-455-0374",
"fax_number": "330-453-6716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1660 NAVE RD SE",
"city": "MASSILLON",
"state": "OH",
"postal_code": "446469604",
"telephone_number": "330-837-9411",
"fax_number": "330-837-4603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "KIMBERLY",
"middle_name": "KAY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-03",
"last_updated": "2019-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "163WA0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "RN365297",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Massillon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.