Individual provider Active NPI

Kimberly Moxley, SLP

  • Speech-Language Pathologist
  • Macon, GA
National Provider Identifier
1588175178
Registry record updated Oct 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP004375 Issued in GA
Practice address
300 Charter Blvd
Macon, GA 31210-4875
Phone
(800) 444-6845
NPI assigned
Oct 23, 2017
Last updated
Oct 23, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SLP004375 GA Primary

Addresses

Primary practice location

300 Charter Blvd
Macon, GA 31210-4875

Mailing address

300 Charter Blvd
Macon, GA 31210-4875

Other identifiers 1

IdentifierTypeStateIssuer
SLP004375OtherGAGA LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220614000137 GA Practitioner - Qualified Speech Language Pathologist 3476932997 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SLP004375GAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Paxxon Healthcare Services LLC CurrentSince May 31, 2022 Accepting new patients
Select Rehabilitation, LLC Speech-Language Pathologist CurrentSince Feb 1, 2024 Accepting new patients
Paxxon Healthcare Services LLC Speech-Language Pathologist CurrentSince May 31, 2022 Accepting new patients
The Weston Group Inc. CurrentSince May 31, 2022 Accepting new patients
The Weston Group Inc. Speech-Language Pathologist CurrentSince May 31, 2022 Accepting new patients

Locations

2725 Holcomb Bridge Rd
Alpharetta, GA 30022
Phone (770) 649-0808

1100 Reinhardt College Pkwy
Canton, GA 30114
Phone (770) 721-2812

Organizations & group practices 5

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": "1508716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508716800000",
    "number": "1588175178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CHARTER BLVD",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312104875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CHARTER BLVD",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312104875",
            "telephone_number": "800-444-6845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOXLEY",
        "first_name": "KIMBERLY",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-23",
        "last_updated": "2017-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP004375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA LICENSE",
            "identifier": "SLP004375",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2017; 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.

Verify at the official NPI Registry.