Active NPI
Jay S Kimbro, RPSGT
- Technician/Technologist
- Stevensville, MD
National Provider Identifier
1366063620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Technician/Technologist
- License
- PSN000036
- Practice address
- 125 E Main St
Stevensville, MD 21666-4001 - Phone
- (865) 771-9123
- NPI assigned
- Apr 28, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Technician/Technologist | 156F00000X | PSN000036 | DC | Primary |
Addresses
Primary practice location
125 E Main St
Stevensville, MD 21666-4001
Mailing address
125 E Main St
Stevensville, MD 21666-4001
Phone (865) 771-9123
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSN000036 | DC | MD | Technician/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588032000000",
"number": "1366063620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 E MAIN ST",
"city": "STEVENSVILLE",
"state": "MD",
"postal_code": "216664001",
"telephone_number": "865-771-9123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 E MAIN ST",
"city": "STEVENSVILLE",
"state": "MD",
"postal_code": "216664001",
"telephone_number": "865-771-9123"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBRO",
"first_name": "JAY",
"middle_name": "S",
"credential": "RPSGT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-04-28",
"last_updated": "2020-04-28",
"certification_date": "2020-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "156F00000X",
"taxonomy_group": "",
"desc": "Technician/Technologist",
"state": "DC",
"license": "PSN000036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stevensville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.