Kymber Broadhead

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

14054 Issued in NC

Practice address

4330 Southport Supply Rd SE Ste 201
Southport, NC 28461-9273

Phone

(910) 612-1002

NPI assigned

May 18, 2020

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

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Carolina Rehabilitation Inc

  • Physical Therapist
  • Supply, NC
  • NPI 1427142561
  NPD
• Adapt Therapy LLC

  • Pediatric Occupational Therapist
  • Meridian, ID
  • NPI 1013683846
  NPD (past)

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

{
    "created_epoch": "1589760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589760000000",
    "number": "1265054852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4330 SOUTHPORT SUPPLY RD SE STE 201",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284619273",
            "telephone_number": "910-612-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4330 SOUTHPORT SUPPLY RD SE STE 201",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284619273",
            "telephone_number": "910-612-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADHEAD",
        "first_name": "KYMBER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-18",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "14054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Boss Urgent Care PLLC
• Elissa B Both, LCSW
• Brad L. Hilaman MD PA
• Lauren Davis Brady
• Christy Renee Bridges, LMBT, RN
• Irene R. Brook, LCSW
• Aaron Lee Brown, D.O.
• Kayde Renee Brown, DPT
• Brunswick Family Medicine PA
• Brunswick Holistic Therapy Inc

• Speech-Language Pathologist in Southport, NC
• Providers in Southport, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2020; 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.