Conway Psychological Assessment Center

Primary specialty

PsychologistTaxonomy code 103T00000X

License

07-27P Issued in AR

Legal business name

CONWAY PSYCHOLOGICAL ASSESSMENT CENTER

Practice address

1210 Hogan LN
Suite 200
Conway, AR 72034-8001

Phone

(501) 932-0255

Fax

(501) 932-0258

NPI assigned

Apr 3, 2012

Last updated

Apr 3, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kim Dielmann, PH.D.NPI 1538371190

Title

Clinical Director

Phone

(501) 932-0255

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kim Dielmann, PH.D.

  • Clinical Psychologist
  • Conway, AR
  • NPI 1538371190
  Medicare reassignment Authorized official
• Jennifer Biggers, PSY.D.

  • Clinical Psychologist
  • Conway, AR
  • NPI 1669985172
  NPD (past)
• Iryna Kasi, PH.D.

  • Psychologist
  • Conway, AR
  • NPI 1396092474
  NPD (past)
• Mindy Lester, LPE

  • Clinical Psychologist
  • Little Rock, AR
  • NPI 1811008105
  NPD (past)
• Nicholas Mitrani, LPE-I

  • Clinical Psychologist
  • Conway, AR
  • NPI 1629426770
  NPD (past)
• Melissa Moix, MS, LPE, SPS

  • Psychologist
  • Conway, AR
  • NPI 1851667349
  NPD (past)
• Bridgette J Powell, MSN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Conway, AR
  • NPI 1275424731
  NPD (past)

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

{
    "created_epoch": "1333411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333411200000",
    "number": "1255697330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 HOGAN LN",
            "address_2": "SUITE 200",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348001",
            "telephone_number": "501-932-0255",
            "fax_number": "501-932-0258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 HOGAN LN",
            "address_2": "SUITE 200",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348001",
            "telephone_number": "501-932-0255",
            "fax_number": "501-932-0258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONWAY PSYCHOLOGICAL ASSESSMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-03",
        "last_updated": "2012-04-03",
        "status": "A",
        "authorized_official_last_name": "DIELMANN",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "501-932-0255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AR",
            "license": "07-27P",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Conway Pain Clinic, PLLC
• Conway Physical Therapy Clinic, PA (Conway Therapy Services)
• Conway Psychiatric Clinic, PLLC
• Conway Public Schools
• Conway Public Schools #01
• Conway Pulmonology Clinic, PA
• Conway Radiology Consultants, LLC
• Conway Regional Health System

• Psychologist in Conway, AR
• Providers in Conway, AR by specialty
• Psychologist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.