Porsha Kimbrough, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN273706 Issued in GA

Practice address

2160 Fountain Dr Ste 100
Snellville, GA 30078-7022

Phone

(678) 344-8268

NPI assigned

Oct 24, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.porshakimbrough@149035.advancedmd-direct.com

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.

• Charleston Counseling Center PC

  dba Lifestance Health

  • Mental Health Counselor
  • Mount Pleasant, SC
  • NPI 1316375678
  Medicare reassignment NPD
• Creative Life Center, LLC

  • Geriatric Psychiatry Physician
  • Grayson, GA
  • NPI 1780227140
  NPD (past)
• Life Healing Center PC

  • Psychiatry Physician
  • Snellville, GA
  • NPI 1104149160
  NPD (past)
• Myrtle Beach Counseling Center

  • Mental Health Counselor
  • Myrtle Beach, SC
  • NPI 1235784661
  NPD (past)

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

{
    "created_epoch": "1698105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1356113252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2078 NUTHATCH DR",
            "city": "HOSCHTON",
            "state": "GA",
            "postal_code": "305485401",
            "telephone_number": "619-301-5315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 FOUNTAIN DR STE 100",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300787022",
            "telephone_number": "678-344-8268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBROUGH",
        "first_name": "PORSHA",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-24",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "SC",
            "license": "29352",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN273706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jae Man Kim, PT
• Jonathan Kim, DDS
• Peter Kim
• Yong S Kim, M.D.
• Janelle Kimbrough, RBT
• Amy Duffy Kingry, CRNA
• Deborah Michelle Kirk, BS
• David Kirtland, PHARM. D
• Bezaye Kitessa
• Meghan Knapp

• Psychiatric/Mental Health Nurse Practitioner in Snellville, GA
• Providers in Snellville, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.