Kimberly Lucille Black, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

2017004149 Issued in MO

Practice address

411 3Rd St
Monett, MO 65708-2008

Phone

(417) 476-1000

Fax

(417) 476-1082

NPI assigned

Jan 19, 2017

Last updated

Feb 28, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ozark Tri-County Health Care ConsortiumGroup PAC ID 8123918257, 38 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ozark Tri-County Health Care Consortium

  dba Access Family Care

  • Federally Qualified Health Center (FQHC)
  • Anderson, MO
  • NPI 1265428791
  Medicare reassignment Care Compare group NPD
• Clark Community Mental Health Center

  • Community/Behavioral Health Agency
  • Monett, MO
  • NPI 1801807771
  Medicare reassignment NPD
• Ozark Tri-County Health Care Consortium

  dba Access Family Care

  • Federally Qualified Health Center (FQHC)
  • Joplin, MO
  • NPI 1649837444
  NPD
• Clark Community Mentalhealth Center

  • Children's Substance Abuse Rehabilitation Facility
  • Monett, MO
  • NPI 1912337692
  NPD (past)

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

{
    "created_epoch": "1484784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488240000000",
    "number": "1255878989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100",
            "city": "PIERCE CITY",
            "state": "MO",
            "postal_code": "657232100",
            "telephone_number": "417-476-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 3RD ST",
            "city": "MONETT",
            "state": "MO",
            "postal_code": "657082008",
            "telephone_number": "417-476-1000",
            "fax_number": "417-476-1082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KIMBERLY",
        "middle_name": "LUCILLE",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-19",
        "last_updated": "2017-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2017004149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shane Micheal Becker, PHARM. D., RPH
• Melanie Nicole Beckham, RN, PMHNP
• Benchmark Healthcare of Monett, LLC
• Lacey Berry, LPC
• Earl Best, LCSW
• Vickie Lynn Blevins, FNP
• Brook Beaumont Bounous, DO
• Charles Bret Bowling, MD
• Allison Elizabeth Brewer, O.D.
• Paul H. Bricker, R.PH.

• Psychiatric/Mental Health Nurse Practitioner in Monett, MO
• Providers in Monett, MO by specialty
• Psychiatric/Mental Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.