Kimerly Ann Pawlicki, M.ED.

Primary specialty

School PsychologistTaxonomy code 103TS0200X

License

1195007 Issued in NC

Practice address

504 Blue Heron Dr
Newport, NC 28570-8008

Phone

(419) 346-2170

NPI assigned

May 15, 2023

Last updated

May 15, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1235820994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 BLUE HERON DR",
            "city": "NEWPORT",
            "state": "NC",
            "postal_code": "285708008",
            "telephone_number": "419-346-2170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 BLUE HERON DR",
            "city": "NEWPORT",
            "state": "NC",
            "postal_code": "285708008",
            "telephone_number": "419-346-2170"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6800 Secor Rd",
            "address_purpose": "LOCATION",
            "city": "Lambertville",
            "state": "MI",
            "postal_code": "481449733",
            "country_code": "US",
            "telephone_number": "419-346-2170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAWLICKI",
        "first_name": "KIMERLY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "M.ED.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-15",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "MI",
            "license": "SP0000001109418",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "NC",
            "license": "1195007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• School Psychologist in Newport, NC
• Providers in Newport, NC by specialty
• School Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.