Active NPI
Kimberly Ann Roberts, IECE
- Developmental Therapist
- Mayslick, KY
National Provider Identifier
1659812493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- License
- 200129228
- Practice address
- 5259 Weaver Rd
Mayslick, KY 41055-8999 - Phone
- (606) 584-7224
- NPI assigned
- Mar 13, 2017
- Last updated
- Apr 4, 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 |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | 200129228 | KY | Primary |
Addresses
Primary practice location
5259 Weaver Rd
Mayslick, KY 41055-8999
Mailing address
5259 Weaver Rd
Mayslick, KY 41055-8999
Phone (606) 584-7224
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 |
|---|---|---|---|
| 200129228 | KY | MD | Developmental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491264000000",
"number": "1659812493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5259 WEAVER RD",
"city": "MAYSLICK",
"state": "KY",
"postal_code": "410558999",
"telephone_number": "606-584-7224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5259 WEAVER RD",
"city": "MAYSLICK",
"state": "KY",
"postal_code": "410558999",
"telephone_number": "606-584-7224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "KIMBERLY",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "IECE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-13",
"last_updated": "2017-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "KY",
"license": "200129228",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mayslick, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 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.