Active NPI
Kimberly Speros, RD CNSC
- Registered Dietitian
- Phoenix, AZ
National Provider Identifier
1407243686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 11002
- Practice address
- 350 W Thomas Rd
Food & Nutrition Department
Phoenix, AZ 85013-4409 - Phone
- (602) 406-3115
- Fax
- (602) 406-6660
- NPI assigned
- Apr 24, 2015
- Last updated
- Apr 24, 2015
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 11002 | CA | Primary |
Addresses
Primary practice location
350 W Thomas Rd
Food & Nutrition Department
Phoenix, AZ 85013-4409
Mailing address
1210 E Northern Ave
Phoenix, AZ 85020-4217
Phone (602) 677-4164
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 |
|---|---|---|---|
| 11002 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429833600000",
"number": "1407243686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1210 E NORTHERN AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850204217",
"telephone_number": "602-677-4164",
"fax_number": "602-532-7146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 W THOMAS RD",
"address_2": "FOOD & NUTRITION DEPARTMENT",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850134409",
"telephone_number": "602-406-3115",
"fax_number": "602-406-6660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPEROS",
"first_name": "KIMBERLY",
"credential": "RD CNSC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-04-24",
"last_updated": "2015-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "11002",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.