Kim Mara Dierickx, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

9111531 Issued in FL

Practice address

100 NW 170TH St Ste 301
North Miami Beach, FL 33169-5511

Phone

(305) 651-3038

Fax

(305) 655-1153

NPI assigned

Feb 21, 2019

Last updated

Feb 21, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1550707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550707200000",
    "number": "1518424951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 NW 170TH ST STE 301",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331695511",
            "telephone_number": "305-651-3038",
            "fax_number": "305-655-1153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NW 170TH ST STE 301",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331695511",
            "telephone_number": "305-651-3038",
            "fax_number": "305-655-1153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIERICKX",
        "first_name": "KIM",
        "middle_name": "MARA",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-21",
        "last_updated": "2019-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "9111531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in North Miami Beach, FL
• Providers in North Miami Beach, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.