Active NPI
Kimberly Thiessen, PSYD
- Psychologist
- Tucson, AZ
National Provider Identifier
1699259986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY-005019
- Practice address
- 1022 W Ina Rd Ste 9
Tucson, AZ 85704-3109 - Phone
- (520) 528-2233
- NPI assigned
- Sep 21, 2018
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY-005019 | AZ | Primary |
Addresses
Primary practice location
1022 W Ina Rd Ste 9
Tucson, AZ 85704-3109
Mailing address
1022 W Ina Rd Ste 9
Tucson, AZ 85704-3109
Phone (520) 528-2233
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 27, 2022 through Oct 27, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-005019 | AZ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542672000000",
"number": "1699259986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1022 W INA RD STE 9",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857043109",
"telephone_number": "520-528-2233"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1022 W INA RD STE 9",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857043109",
"telephone_number": "520-528-2233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THIESSEN",
"first_name": "KIMBERLY",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-21",
"last_updated": "2018-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AZ",
"license": "PSY-005019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2018; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.