Active NPI
Kimberly Draine
- Home Health Aide
- Lakeland, FL
National Provider Identifier
1336661883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- Practice address
- 1112 W 12TH St
Lakeland, FL 33805-3465 - Phone
- (863) 838-4042
- NPI assigned
- Jul 15, 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 |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | Primary |
Addresses
Primary practice location
1112 W 12TH St
Lakeland, FL 33805-3465
Mailing address
3617 Frontage Rd N
Lakeland, FL 33810-2891
Phone (863) 838-4042
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 019404200 | Medicaid | FL |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500076800000",
"number": "1336661883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3617 FRONTAGE RD N",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338102891",
"telephone_number": "863-838-4042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1112 W 12TH ST",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338053465",
"telephone_number": "863-838-4042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRAINE",
"first_name": "KIMBERLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-07-15",
"last_updated": "2017-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "019404200",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.