Active NPI
Kimyatta Simone Gibson, LMSW
- Social Worker
- Birmingham, AL
National Provider Identifier
1245765379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 3695G
- Practice address
- 700 19TH St S
Birmingham, AL 35233-1927 - Phone
- (205) 933-8101
- Fax
- (205) 212-3173
- NPI assigned
- Apr 26, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 3695G | AL | Primary |
Addresses
Primary practice location
700 19TH St S
Birmingham, AL 35233-1927
Mailing address
5422 Balboa Cir
Pinson, AL 35126-3516
Phone (205) 933-8101
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 |
|---|---|---|---|
| 3695G | AL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493164800000",
"number": "1245765379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5422 BALBOA CIR",
"city": "PINSON",
"state": "AL",
"postal_code": "351263516",
"telephone_number": "205-933-8101",
"fax_number": "205-212-3173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 19TH ST S",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352331927",
"telephone_number": "205-933-8101",
"fax_number": "205-212-3173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "KIMYATTA",
"middle_name": "SIMONE",
"name_prefix": "Mrs.",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-26",
"last_updated": "2017-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "AL",
"license": "3695G",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.