Kelly Renee Zimmerman, AADCP-IP

Primary specialty

Religious Nonmedical PractitionerTaxonomy code 374K00000X

Practice address

706 Waxwing CT
Boiling Springs, SC 29316-5379

Phone

(864) 541-2755

NPI assigned

Jun 17, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1371427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1609215227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 WAXWING CT",
            "city": "BOILING SPRINGS",
            "state": "SC",
            "postal_code": "293165379",
            "telephone_number": "864-541-2755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 WAXWING CT",
            "city": "BOILING SPRINGS",
            "state": "SC",
            "postal_code": "293165379",
            "telephone_number": "864-541-2755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIMMERMAN",
        "first_name": "KELLY",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "AADCP-IP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-17",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "374K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Religious Nonmedical Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shamai Aviona Wyatt
• Alexis Young, PA-C
• Kim Young
• Shericka Ciera Young, LPC
• Aleksey Zelenko, DMD
• Sarrah Marie Zura

• Religious Nonmedical Practitioner in Boiling Springs, SC
• Providers in Boiling Springs, SC by specialty
• Religious Nonmedical Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.