Active NPI
Kimberly Michelle Trickett, LCSW
- Clinical Social Worker
- Fort Worth, TX
National Provider Identifier
1356087613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 64621
- Practice address
- 2603 Lasalle St
Fort Worth, TX 76111-1146 - Phone
- (817) 896-2582
- NPI assigned
- May 10, 2022
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 64621 | TX | Primary |
Addresses
Primary practice location
2603 Lasalle St
Fort Worth, TX 76111-1146
Mailing address
2603 Lasalle St
Fort Worth, TX 76111-1146
Phone (817) 896-2582
Other names 1
- Kimberly Trickett Bushlow
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64621 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711411200000",
"number": "1356087613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2603 LASALLE ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761111146",
"telephone_number": "817-896-2582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2603 LASALLE ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761111146",
"telephone_number": "817-896-2582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRICKETT",
"first_name": "KIMBERLY",
"middle_name": "MICHELLE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-10",
"last_updated": "2024-03-26",
"certification_date": "2023-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "64621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KIMBERLY",
"last_name": "BUSHLOW",
"middle_name": "TRICKETT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.