Active NPI
Kimberly Dawn Warren, LMT
- Specialist
- South Charleston, WV
National Provider Identifier
1710198858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 2002-1006
- Practice address
- 4834 Maccorkle Ave SW
South Charleston, WV 25309-1340 - Phone
- (304) 755-2045
- NPI assigned
- May 24, 2007
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 2002-1006 | WV | Primary |
Addresses
Primary practice location
4834 Maccorkle Ave SW
South Charleston, WV 25309-1340
Mailing address
108 Greenbrier Dr
Scott Depot, WV 25560-9699
Phone (304) 755-2045
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 |
|---|---|---|---|
| 2002-1006 | WV | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710198858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 GREENBRIER DR",
"city": "SCOTT DEPOT",
"state": "WV",
"postal_code": "255609699",
"telephone_number": "304-755-2045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4834 MACCORKLE AVE SW",
"city": "SOUTH CHARLESTON",
"state": "WV",
"postal_code": "253091340",
"telephone_number": "304-755-2045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARREN",
"first_name": "KIMBERLY",
"middle_name": "DAWN",
"name_prefix": "Ms.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WV",
"license": "2002-1006",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.