Active NPI
Jennifer Kimberly, COTA/L
- Specialist
- Clovis, NM
National Provider Identifier
1720228679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 2553
- Practice address
- 810 E 21St St
Clovis, NM 88101-4442 - Phone
- (575) 763-9517
- NPI assigned
- Mar 4, 2009
- Last updated
- Mar 4, 2009
- 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 | 2553 | NM | Primary |
Addresses
Primary practice location
810 E 21St St
Clovis, NM 88101-4442
Mailing address
810 E 21St St
Suite 6a
Clovis, NM 88101-4442
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 |
|---|---|---|---|
| 2553 | NM | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236124800000",
"number": "1720228679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "810 E 21ST ST",
"address_2": "SUITE 6A",
"city": "CLOVIS",
"state": "NM",
"postal_code": "881014442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "810 E 21ST ST",
"city": "CLOVIS",
"state": "NM",
"postal_code": "881014442",
"telephone_number": "575-763-9517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBERLY",
"first_name": "JENNIFER",
"name_prefix": "Mrs.",
"credential": "COTA/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-03-04",
"last_updated": "2009-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NM",
"license": "2553",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clovis, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.