Active NPI
Kim Marie Briden, P.T.
- Contractor
- Charlotte, NC
National Provider Identifier
1568612240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 2395
- Practice address
- 13805 Appling Lane
Charlotte, NC 28278 - Phone
- (704) 504-8307
- Fax
- (704) 504-8307
- NPI assigned
- Sep 30, 2008
- Last updated
- Sep 30, 2008
- 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 |
|---|---|---|---|---|
| Contractor | 171W00000X | 2395 | NC | Primary |
Addresses
Primary practice location
13805 Appling Lane
Charlotte, NC 28278
Mailing address
3724 National Drive
Suite 110
Raleigh, NC 27612
Phone (919) 781-9565
Other names 1
- Kim Marie Pagendarm
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2395 | NC | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222732800000",
"number": "1568612240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3724 NATIONAL DRIVE",
"address_2": "SUITE 110",
"city": "RALEIGH",
"state": "NC",
"postal_code": "27612",
"telephone_number": "919-781-9565",
"fax_number": "919-781-9564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13805 APPLING LANE",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "28278",
"telephone_number": "704-504-8307",
"fax_number": "704-504-8307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRIDEN",
"first_name": "KIM",
"middle_name": "MARIE",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-30",
"last_updated": "2008-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "NC",
"license": "2395",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KIM",
"last_name": "PAGENDARM",
"middle_name": "MARIE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.