Active NPI
Kimberley E Jongebloed, MD
- Family Medicine Physician
- Bayou la Batre, AL
National Provider Identifier
1720057490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 11512
- Practice address
- 13833 Tapia Ave
Bayou la Batre, AL 36509-2515 - Phone
- (251) 824-4985
- Fax
- (251) 824-4990
- NPI assigned
- Mar 15, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 11512 | AL | Primary |
Addresses
Primary practice location
13833 Tapia Ave
Bayou la Batre, AL 36509-2515
Mailing address
1209 Marseille Dr
Mobile, AL 36693-4521
Phone (251) 824-4985
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11512 | AL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227571200000",
"number": "1720057490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1209 MARSEILLE DR",
"city": "MOBILE",
"state": "AL",
"postal_code": "366934521",
"telephone_number": "251-824-4985",
"fax_number": "251-824-4990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13833 TAPIA AVE",
"city": "BAYOU LA BATRE",
"state": "AL",
"postal_code": "365092515",
"telephone_number": "251-824-4985",
"fax_number": "251-824-4990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JONGEBLOED",
"first_name": "KIMBERLEY",
"middle_name": "E",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-15",
"last_updated": "2008-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AL",
"license": "11512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bayou la Batre, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.