Active NPI
Stacy Kimbrough
- Case Manager/Care Coordinator
- West Deptford, NJ
National Provider Identifier
1609315563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- 687697
- Practice address
- 701 W Red Bank Ave
West Deptford, NJ 08096-4950 - Phone
- (347) 226-0247
- NPI assigned
- Feb 13, 2017
- 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 |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 687697 | PA | Primary |
Addresses
Primary practice location
701 W Red Bank Ave
West Deptford, NJ 08096-4950
Mailing address
701 W Red Bank Ave
West Deptford, NJ 08096-4950
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 |
|---|---|---|---|
| 687697 | PA | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486944000000",
"number": "1609315563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 W RED BANK AVE",
"city": "WEST DEPTFORD",
"state": "NJ",
"postal_code": "080964950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 W RED BANK AVE",
"city": "WEST DEPTFORD",
"state": "NJ",
"postal_code": "080964950",
"telephone_number": "347-226-0247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBROUGH",
"first_name": "STACY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-02-13",
"last_updated": "2017-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "PA",
"license": "687697",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Deptford, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.