Kimberly Dawn Smith

Primary specialty

Case Management Registered NurseTaxonomy code 163WC0400X

License

041376465 Issued in IL

Practice address

2030 Lewis Rd
Harrisburg, IL 62946-4385

Phone

(618) 926-1401

NPI assigned

Mar 28, 2023

Sex

Female

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1225732829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 W MAIN ST",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629591188",
            "telephone_number": "618-997-5311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 LEWIS RD",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629464385",
            "telephone_number": "618-926-1401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KIMBERLY",
        "middle_name": "DAWN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-28",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "IL",
            "license": "041376465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela L Shires, RN
• Sandy Shortland
• Linda K Sims
• Billy G Smith
• Charli Walter Leroy Smith Jr., M.D.
• Mary Darlene Smith
• Patricia Smith, MD
• Pennie Lowanda Smith, PA
• Southeastern Residential Alternatives, Inc.
• Southern Illinois Hospital Services

• All providers in Harrisburg, IL
• Case Management Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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.