Kim Dewayne Kemmerly, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7322 Issued in NV

Practice address

5905 W Charleston Blvd Apt 250
Las Vegas, NV 89146-1375

Phone

(318) 332-6347

NPI assigned

Mar 31, 2020

Last updated

Mar 31, 2020By the provider in NPPES

Sex

Male

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 NV

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1585612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585612800000",
    "number": "1356979603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5905 W CHARLESTON BLVD APT 250",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461375",
            "telephone_number": "318-332-6347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5905 W CHARLESTON BLVD APT 250",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461375",
            "telephone_number": "318-332-6347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEMMERLY",
        "first_name": "KIM",
        "middle_name": "DEWAYNE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-31",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "7322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandy Kelson
• Kimberly Kelting
• Kara Kemerson, MA, LCPC
• Star Kemfort
• Scot Kemmer
• Gladys Kemp-Williams
• Amber Marie Kemp
• Charmaine Donnise Kemp
• Darrius Mavin Kemp
• Marquis Kemp

• General Practice Dentistry in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• General Practice Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2020; 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.