Kimber Kathleen Watson Nelson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10106906-1206 Issued in UT

Practice address

395 W Cougar Blvd Ste 205
Provo, UT 84604-3328

Phone

(801) 357-1770

Fax

(801) 357-1779

NPI assigned

Dec 2, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, UT2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Sandy, UT
  • NPI 1942325154
  Medicare reassignment Care Compare group
• Columbia Emergency Medical Group Inc

  • Emergency Medicine Physician
  • Long Beach, CA
  • NPI 1871551119
  Medicare reassignment
• Ihc Health Services Inc

  • Orthopaedic Surgery Physician
  • Riverton, UT
  • NPI 1952563579
  NPD
• Ihc Health Services, Inc.

  • Psychiatry Physician
  • St George, UT
  • NPI 1023843844
  NPD
• Pioneer Medical Group Inc.

  • Multi-Specialty Clinic/Center
  • Bellflower, CA
  • NPI 1548303589
  NPD (past)

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

{
    "created_epoch": "1259712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1689902603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 W COUGAR BLVD STE 205",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043328",
            "telephone_number": "801-357-1770",
            "fax_number": "801-357-1779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17777 Center Court Dr N",
            "address_2": "Suite 400",
            "address_purpose": "LOCATION",
            "city": "Cerritos",
            "state": "CA",
            "postal_code": "907038567",
            "country_code": "US",
            "telephone_number": "562-229-9452",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATSON NELSON",
        "first_name": "KIMBER",
        "middle_name": "KATHLEEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-02",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA20714",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "10106906-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wasatch Mental Health
• Nicole Wassom
• Alyssa Watkins
• Aubrey Watkins, MSWI
• Jana Watkins
• Skye Watson
• Hugh D Watt, LCSW
• Clayton Watts, MD
• David Michael Watts, M.D.
• Gary M Watts, MD

• Physician Assistant in Provo, UT
• Providers in Provo, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.