Kimberley Anne Backstrom – Social Worker

Key facts

NPI: 1447714647
Entity type: Individual (NPI type 1)
Primary specialty: Social Worker 104100000X
License: 1358P-S (NV)
Practice address: 300 E Charleston Blvd Ste 216
Las Vegas, NV 89104-1042
Phone: (702) 247-1145
NPI assigned: Jan 22, 2019
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
ASW87254	CA	MD	Mental Health Counselor
1358P-S	NV	MD	Social Worker

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Mental Health Counselor	101YM0800X	ASW87254	CA
Social Worker	104100000X	1358P-S	NV	Yes

Addresses

Primary practice location

300 E Charleston Blvd Ste 216
Las Vegas, NV 89104-1042

Mailing address

7715 Ornamento Way
Las Vegas, NV 89179-1825
Phone (702) 247-1145

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 8, 2020.

{
    "created_epoch": "1548115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1447714647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7715 ORNAMENTO WAY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891791825",
            "telephone_number": "702-247-1145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E CHARLESTON BLVD STE 216",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891041042",
            "telephone_number": "702-247-1145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACKSTROM",
        "first_name": "KIMBERLEY",
        "middle_name": "ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-22",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW87254",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NV",
            "license": "1358P-S",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

All providers in Las Vegas, NV · Social Worker in Nevada

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.