Individual provider Active NPI

Kimberly Prevost

  • Marriage & Family Therapist
  • San Diego, CA
National Provider Identifier
1396309381
Registry record updated May 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
155210 Issued in CA
Practice address
8880 Cassioepia Way
San Diego, CA 92126-1465
Phone
(858) 922-1480
NPI assigned
Apr 25, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 106H00000X 155210 CA Primary

Addresses

Primary practice location

8880 Cassioepia Way
San Diego, CA 92126-1465

Mailing address

8880 Cassioepia Way
San Diego, CA 92126-1465
Phone (858) 922-1480

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250624002534 CA Practitioner - Marriage and Family Therapist 7810409059 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PC Marriage & Family Therapist CurrentSince May 16, 2025 Accepting new patients
Community Research Foundation Inc Past Accepting new patients

Locations

99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1556150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748131200000",
    "number": "1396309381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8880 CASSIOEPIA WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921261465",
            "telephone_number": "858-922-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8880 CASSIOEPIA WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921261465",
            "telephone_number": "858-922-1480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREVOST",
        "first_name": "KIMBERLY",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-25",
        "last_updated": "2025-05-25",
        "certification_date": "2025-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "155210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.