Individual provider Active NPI

Kimberly Nicole Painter, PSYD

  • Clinical Neuropsychologist
  • Phoenix, AZ
National Provider Identifier
1467790881
Registry record updated Aug 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PSY-005002 Issued in AZ
Practice address
1919 E Thomas Rd
Phoenix, AZ 85016
Phone
(602) 933-0414
Fax
(602) 933-4252
NPI assigned
Jan 18, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Psychologist 103T00000X 2016032456 MO
Clinical Neuropsychologist 103G00000X PSY-005002 AZ Primary

Addresses

Primary practice location

1919 E Thomas Rd
Phoenix, AZ 85016

Mailing address

3200 E Camelback Rd Ste 250
Phoenix, AZ 85018-2327
Phone (602) 933-1813

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181005002686 AZ Practitioner - Clinical Psychologist 5294087037 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY-005002AZMDClinical Neuropsychologist
2016032456MOMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Children'S Hospital Current Accepting new patients
Phoenix Children'S Medical Group CurrentSince Sep 1, 2018 Accepting new patients
Phoenix Children'S Medical Group CurrentSince Sep 1, 2018 Accepting new patients

Locations

3370 S Mercy Rd
Ste 218
Gilbert, AZ 85297
Phone (602) 933-0990

3420 S Mercy Rd
Ste 113
Gilbert, AZ 85297
Phone (480) 219-3346

1919 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 933-0777

3200 E Camelback Rd
Ste 250
Phoenix, AZ 85018
Phone (602) 933-1814

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535414400000",
    "number": "1467790881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 E CAMELBACK RD STE 250",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850182327",
            "telephone_number": "602-933-1813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 E THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85016",
            "telephone_number": "602-933-0414",
            "fax_number": "602-933-4252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAINTER",
        "first_name": "KIMBERLY",
        "middle_name": "NICOLE",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-18",
        "last_updated": "2018-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MO",
            "license": "2016032456",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "AZ",
            "license": "PSY-005002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.