Kimberlyn Jena Wilson, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT013404 Issued in GA

Practice address

260 W Clinton St Ste 2
Gray, GA 31032-5464

Phone

(478) 936-7621

Fax

(888) 369-9044

NPI assigned

Jul 31, 2019

Last updated

Dec 26, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hometown Orthopedic and Sports Rehabilitation LLCGroup PAC ID 0446620744, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hometown Orthopedic and Sports Rehabilitation LLC

  dba Hometown Ortho and Sports Rehab

  • Physical Therapist
  • Gray, GA
  • NPI 1255060307
  Medicare reassignment Care Compare group NPD Authorized official
• Houston Orthopedic Surgery & Sports Medicine, P.C.

  • Orthopaedic Surgery Physician
  • Warner Robins, GA
  • NPI 1205866605
  Medicare reassignment NPD
• Houston Orthopedic Surgery & Sports Medicine, P.C.

  dba Middle Georgia Orthopedics

  • Durable Medical Equipment & Medical Supplies
  • Perry, GA
  • NPI 1134563042
  NPD

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

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672012800000",
    "number": "1710531306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "162 SHOAL CREEK RD",
            "city": "ROUND OAK",
            "state": "GA",
            "postal_code": "310383001",
            "telephone_number": "478-550-3702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 W CLINTON ST STE 2",
            "city": "GRAY",
            "state": "GA",
            "postal_code": "310325464",
            "telephone_number": "478-936-7621",
            "fax_number": "888-369-9044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KIMBERLYN",
        "middle_name": "JENA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-31",
        "last_updated": "2022-12-26",
        "certification_date": "2022-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT013404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "hometownorthoandsportsrehab@gmail.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "260 W Clinton St Ste 2",
            "city": "Gray",
            "state": "GA",
            "country_code": "US",
            "postal_code": "310325464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Willie Mack Watts, PA
• West Clinton Family Dentistry, LLC
• Kayla Sue Whitley, DNP, APRN, FNP-C
• Michael Christopher Williamson, LMFT
• Catherine Marie Wilson, FNP
• Sandra Baird Wilson, FNP-C
• Jennifer Nicole Woodall, FNP-C
• Tanya Watts Zellner, LPC

• Physical Therapist in Gray, GA
• Providers in Gray, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.