Active NPI
Kimberly D Wilson
- Dental Hygienist
- Olivehurst, CA
National Provider Identifier
1447772124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 24554
- Practice address
- 4941 Olivehurst Ave
Olivehurst, CA 95961-4225 - Phone
- (530) 743-4614
- NPI assigned
- Jul 13, 2017
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 24554 | CA | Primary |
Addresses
Primary practice location
4941 Olivehurst Ave
Olivehurst, CA 95961-4225
Mailing address
935 Market St
Yuba City, CA 95991-4217
Phone (916) 292-2377
Other practice location 1
2240 E. Winrow Ave
US Army Dental Clinic Command
fort Huachauca, AA 85613
Phone (520) 533-3144
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24554 | CA | MD | Orthopedic Physical Therapist |
Interoperability endpoints
- kimberly.wilson.p1@direct.cmcentersinc.nextgenshare.com
- kimberly.wilson@wsmc1.eclinicaldirectplus.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600300800000",
"number": "1447772124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "935 MARKET ST",
"city": "YUBA CITY",
"state": "CA",
"postal_code": "959914217",
"telephone_number": "916-292-2377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4941 OLIVEHURST AVE",
"city": "OLIVEHURST",
"state": "CA",
"postal_code": "959614225",
"telephone_number": "530-743-4614"
}
],
"practiceLocations": [
{
"address_1": "2240 E. Winrow Ave",
"address_2": "US Army Dental Clinic Command",
"address_purpose": "LOCATION",
"city": "fort Huachauca",
"state": "AA",
"postal_code": "85613",
"country_code": "US",
"telephone_number": "520-533-3144",
"country_name": "United States",
"address_type": "MIL"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "KIMBERLY",
"middle_name": "D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-13",
"last_updated": "2020-09-17",
"certification_date": "2020-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CA",
"license": "24554",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olivehurst, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.