Active NPI
Kimble Dynetta Davis, LCPC
- Professional Counselor
- Texarkana, AR
National Provider Identifier
1447316765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180005837
- Practice address
- 701 Arkansas Blvd
Texarkana, AR 71854-2105 - Phone
- (870) 772-5028
- NPI assigned
- Dec 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180005837 | IL | Primary |
Addresses
Primary practice location
701 Arkansas Blvd
Texarkana, AR 71854-2105
Mailing address
925 N Walkers Corner Rd
Scott, AR 72142-9409
Phone (870) 514-9088
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 |
|---|---|---|---|
| 180005837 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489536000000",
"number": "1447316765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "925 N WALKERS CORNER RD",
"city": "SCOTT",
"state": "AR",
"postal_code": "721429409",
"telephone_number": "870-514-9088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 ARKANSAS BLVD",
"city": "TEXARKANA",
"state": "AR",
"postal_code": "718542105",
"telephone_number": "870-772-5028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "KIMBLE",
"middle_name": "DYNETTA",
"name_prefix": "Ms.",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-29",
"last_updated": "2017-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180005837",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Texarkana, AR
- Sade Darlington, MHPP
- Darnell Brown Community Development Corporation
- Chelsie Davenport
- David Ashley MD DMD Oral Surgery Group, a Professional Dental Corp
- Jon William Davis, R.N.
- Michelle Davis, LPC
- Sharon Ann Davis, BAAS, MS
- Lashonna Faith Dawnta-Cooper
- Perri Dawson I, RCIS, RT, (R)(CI)ARR
- Robert M Day, MHPP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.