NPIMap

Organization Active NPI

Kimila Deflanders LCSW LLC

  • Clinical Social Worker
  • Gulfport, MS
National Provider Identifier
1588217699
Registry record updated May 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
KIMILA DEFLANDERS LCSW LLC
Practice address
1390 29TH Ave Ste B
Gulfport, MS 39501-1945
Phone
(601) 557-2185
Fax
(228) 220-4303
NPI assigned
Jul 17, 2019
Last updated
May 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2022

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

Authorized official

Name
Mrs. Kimila Deflanders, LCSWNPI 1194767889
Title
Owner/Therapist
Phone
(601) 557-2185

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

1390 29TH Ave Ste B
Gulfport, MS 39501-1945

Mailing address

PO Box 8024
Biloxi, MS 39535-8024
Phone (601) 557-2185

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190724000119 MS Part B Supplier - Clinic/Group Practice 4880920230 Receives reassigned benefits from 1 practitioner
Practice locations: Gulfport, MS

National Provider Directory

National Provider Directory

Locations

1390 29th Ave
#B
Gulfport, MS 39501
Phone (228) 220-4226

2715 Bullis Ave
Gulfport, MS 39501
Phone (228) 220-4226

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1563321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653264000000",
    "number": "1588217699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8024",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395358024",
            "telephone_number": "601-557-2185",
            "fax_number": "228-220-4303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1390 29TH AVE STE B",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395011945",
            "telephone_number": "601-557-2185",
            "fax_number": "228-220-4303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMILA DEFLANDERS LCSW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-17",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A",
        "authorized_official_last_name": "DEFLANDERS",
        "authorized_official_first_name": "KIMILA",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "601-557-2185",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; 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.