Active NPI
Kimberly Nicole Sta Ana Henson, PT
- Physical Therapist
- Clovis, NM
National Provider Identifier
1508559964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6123
- Practice address
- 1609 N Prince St
Clovis, NM 88101-4850 - Phone
- (575) 935-0360
- Fax
- (575) 935-0361
- NPI assigned
- May 31, 2023
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 6123 | NM | Primary |
Addresses
Primary practice location
1609 N Prince St
Clovis, NM 88101-4850
Mailing address
6 N Oak St
Perryville, MO 63775-2733
Phone (573) 768-5958
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230724003677 | NM | Practitioner - Physical Therapist in Private Practice | 7315307287 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6123 | NM | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Zia Rehab Solutions LLC | Physical Therapist | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapy Clinic/Center
- Farmington, NM
- NPI 1275342958
NM, Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685836800000",
"number": "1508559964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 N OAK ST",
"city": "PERRYVILLE",
"state": "MO",
"postal_code": "637752733",
"telephone_number": "573-768-5958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1609 N PRINCE ST",
"city": "CLOVIS",
"state": "NM",
"postal_code": "881014850",
"telephone_number": "575-935-0360",
"fax_number": "575-935-0361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENSON",
"first_name": "KIMBERLY NICOLE",
"middle_name": "STA ANA",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-05-31",
"last_updated": "2023-06-04",
"certification_date": "2023-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "6123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clovis, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.