Active NPI
Kimberly Kay Rose
- Community Health Worker
- Marion, AR
National Provider Identifier
1710154075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 147802783
- Practice address
- 421 Birdie Dr
Apt. #3
Marion, AR 72364-1647 - Phone
- (901) 277-8968
- NPI assigned
- May 14, 2008
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 147802783 | AR | Primary |
Addresses
Primary practice location
421 Birdie Dr
Apt. #3
Marion, AR 72364-1647
Mailing address
421 Birdie Dr
Apt. #3
Marion, AR 72364-1647
Phone (901) 277-8968
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 147802783 | Medicaid | AR |
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 |
|---|---|---|---|
| 147802783 | AR | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210723200000",
"number": "1710154075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "421 BIRDIE DR",
"address_2": "APT. #3",
"city": "MARION",
"state": "AR",
"postal_code": "723641647",
"telephone_number": "901-277-8968"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "421 BIRDIE DR",
"address_2": "APT. #3",
"city": "MARION",
"state": "AR",
"postal_code": "723641647",
"telephone_number": "901-277-8968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "KIMBERLY",
"middle_name": "KAY",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-14",
"last_updated": "2008-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "AR",
"license": "147802783",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "147802783",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marion, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.