Active NPI
Kimberly Tanner
- Speech-Language Pathologist
- Cypress, TX
National Provider Identifier
1427770593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 101057
- Practice address
- 21757 Fairfield Place Dr
Cypress, TX 77433-3196 - Phone
- (281) 373-2400
- NPI assigned
- Sep 15, 2022
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 101057 | TX | Primary |
Addresses
Primary practice location
21757 Fairfield Place Dr
Cypress, TX 77433-3196
Mailing address
16622 Hearty Orange Dr
Cypress, TX 77433-6437
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609917541 | Medicaid | TX |
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 |
|---|---|---|---|
| 101057 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663200000000",
"number": "1427770593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16622 HEARTY ORANGE DR",
"city": "CYPRESS",
"state": "TX",
"postal_code": "774336437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21757 FAIRFIELD PLACE DR",
"city": "CYPRESS",
"state": "TX",
"postal_code": "774333196",
"telephone_number": "281-373-2400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANNER",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-15",
"last_updated": "2022-09-15",
"certification_date": "2022-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "101057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1609917541",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cypress, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.