Individual provider Active NPI

Kimberley Ann Klimowicz, MSN RN NPP

  • Psychiatric/Mental Health Nurse Practitioner
  • Syracuse, NY
National Provider Identifier
1548690589
Registry record updated Aug 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
405851 Issued in NY
Practice address
719 Harrison St
Syracuse, NY 13210-2695
Phone
(315) 464-3265
Fax
(315) 464-3282
NPI assigned
Nov 12, 2013
Last updated
Aug 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 405851 NY Primary
Registered Nurse 163W00000X 649130 NY

Addresses

Primary practice location

719 Harrison St
Syracuse, NY 13210-2695

Mailing address

719 Harrison St
Syracuse, NY 13210-2695
Phone (315) 464-3265

Other names 1

  • Kimberley Ann Pieniazek Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240821004745 NY Practitioner - Nurse Practitioner 7517406507 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
649130NYMDRegistered Nurse
405851NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Psychiatry Faculty Practice, Inc. CurrentSince Aug 1, 2024 Accepting new patients

Locations

713 Harrison St
Bldg 3
Syracuse, NY 13210
Phone (315) 464-3265

719 Harrison St
Syracuse, NY 13210
Phone (315) 464-3265

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

Interoperability endpoints

  • Direct secure messaging: kklimowicz145515@direct.upstate.edu

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1384214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1548690589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 HARRISON ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102695",
            "telephone_number": "315-464-3265",
            "fax_number": "315-464-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 HARRISON ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102695",
            "telephone_number": "315-464-3265",
            "fax_number": "315-464-3282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLIMOWICZ",
        "first_name": "KIMBERLEY",
        "middle_name": "ANN",
        "credential": "MSN RN NPP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-12",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "405851",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "649130",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLEY",
            "last_name": "PIENIAZEK",
            "middle_name": "ANN",
            "credential": "BSN RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.