Active NPI
Kimberly Broyles Tepker, LPC
- Professional Counselor
- Suwanee, GA
National Provider Identifier
1588091102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 03810
- Practice address
- 4485 Tench Rd
Suite 840
Suwanee, GA 30024-6739 - Phone
- (770) 490-6545
- NPI assigned
- Sep 27, 2013
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 03810 | GA | Primary |
Addresses
Primary practice location
4485 Tench Rd
Suite 840
Suwanee, GA 30024-6739
Mailing address
381 Creek Manor Way
Suwanee, GA 30024-6565
Phone (770) 490-6545
Other names 1
- Kimberly Broyles Reddick
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 22, 2024 through Jan 22, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03810 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407196800000",
"number": "1588091102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "381 CREEK MANOR WAY",
"city": "SUWANEE",
"state": "GA",
"postal_code": "300246565",
"telephone_number": "770-490-6545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4485 TENCH RD",
"address_2": "SUITE 840",
"city": "SUWANEE",
"state": "GA",
"postal_code": "300246739",
"telephone_number": "770-490-6545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEPKER",
"first_name": "KIMBERLY",
"middle_name": "BROYLES",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-09-27",
"last_updated": "2014-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "03810",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KIMBERLY",
"last_name": "REDDICK",
"middle_name": "BROYLES",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Suwanee, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.