Kimberly Allen, LCSW
Individual provider Active NPI Clinical Social Worker · Leakesville, MS
NPI 1497280606 · NPPES record last updated Apr 25, 2017
Key facts
- NPI
- 1497280606
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 5830 (TN)
- Practice address
- 22689 Highway 63
Leakesville, MS 39451-5662 - Phone
- (601) 394-5600
- NPI assigned
- Apr 25, 2017
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2005
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
66 E Flagler St
Miami, FL 33130-1807
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS, TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260407003853 | MS | Practitioner - Clinical Social Worker | 2769957786 | Reassigns benefits to 1 organization |
| I20260408002379 | TN | Practitioner - Clinical Social Worker | 2769957786 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C6843 | MS | MD | Clinical Social Worker |
| 5830 | TN | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 5830 | TN | Yes |
| Clinical Social Worker | 1041C0700X | C6843 | MS |
Addresses
Primary practice location
22689 Highway 63
Leakesville, MS 39451-5662
Mailing address
33 Charleston Way
Hattiesburg, MS 39402-7553
Phone (601) 270-0718
NPI Registry JSON
{
"created_epoch": "1493078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493078400000",
"number": "1497280606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33 CHARLESTON WAY",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394027553",
"telephone_number": "601-270-0718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22689 HIGHWAY 63",
"city": "LEAKESVILLE",
"state": "MS",
"postal_code": "394515662",
"telephone_number": "601-394-5600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALLEN",
"first_name": "KIMBERLY",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-25",
"last_updated": "2017-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TN",
"license": "5830",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MS",
"license": "C6843",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leakesville, MS
- Sherrill Hope Backstrom
- Bethany Ballenger
- Madison Bohannon
- Jason S. Box
- Choice Primary Healthcare PLLC
All providers in Leakesville, MS · Clinical Social Worker in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.