Active NPI
Kimberly Anne Holman, MT
- Community Health Worker
- Salem, OR
National Provider Identifier
1396912549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 4760
- Practice address
- 910 Capitol St NE
Suite B
Salem, OR 97301-1201 - Phone
- (503) 391-2979
- Fax
- (503) 581-8389
- NPI assigned
- May 15, 2008
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 4760 | OR | Primary |
Addresses
Primary practice location
910 Capitol St NE
Suite B
Salem, OR 97301-1201
Mailing address
PO Box 3662
Salem, OR 97302-0662
Phone (503) 391-2979
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
- Credentials
- Medical Technician
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210809600000",
"number": "1396912549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3662",
"city": "SALEM",
"state": "OR",
"postal_code": "973020662",
"telephone_number": "503-391-2979",
"fax_number": "503-581-8389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "910 CAPITOL ST NE",
"address_2": "SUITE B",
"city": "SALEM",
"state": "OR",
"postal_code": "973011201",
"telephone_number": "503-391-2979",
"fax_number": "503-581-8389"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLMAN",
"first_name": "KIMBERLY",
"middle_name": "ANNE",
"name_prefix": "Ms.",
"credential": "MT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-15",
"last_updated": "2008-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OR",
"license": "4760",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.