Individual provider Active NPI

Kimberly Perkins, AU.D.

  • Audiologist
  • Jacksonville, FL
National Provider Identifier
1609982966
Registry record updated Jan 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
AY1734 Issued in FL
Practice address
1128 N Laura St
Jacksonville, FL 32206-4912
Phone
(904) 355-3403
Fax
(904) 355-4149
NPI assigned
Aug 21, 2006
Last updated
Jan 5, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X AY1734 FL Primary

Addresses

Primary practice location

1128 N Laura St
Jacksonville, FL 32206-4912

Mailing address

1128 N Laura St
Jacksonville, FL 32206-4912
Phone (904) 355-3403

Other identifiers 3

IdentifierTypeStateIssuer
05700224OtherBLUE CROSS BLUE SHIELD
147-000679OtherILSTATE LICENSE #
011817500MedicaidFL

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Glenn Knox MD PSC CurrentSince Sep 10, 2012 Accepting new patients
Connect Hearing, Inc. Audiologist Past Accepting new patients

Locations

12276 San Jose Blvd
Ste 516
Jacksonville, FL 32223
Phone (904) 292-9777

Organizations & group practices 2

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": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420416000000",
    "number": "1609982966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1128 N LAURA ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322064912",
            "telephone_number": "904-355-3403",
            "fax_number": "904-355-4149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1128 N LAURA ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322064912",
            "telephone_number": "904-355-3403",
            "fax_number": "904-355-4149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERKINS",
        "first_name": "KIMBERLY",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2015-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "FL",
            "license": "AY1734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "05700224",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "147-000679",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011817500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2015; 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.