Active NPI
Kimberly Conrad
- Professional Counselor
- Springfield, MO
National Provider Identifier
1720435431
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2004014918
- Practice address
- 1111 S Glenstone Ave
Suite 3-100
Springfield, MO 65804-0338 - Phone
- (417) 869-8911
- NPI assigned
- May 23, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 2016038827 | MO | |
| Professional Counselor | 101YP2500X | 2004014918 | MO | Primary |
Addresses
Primary practice location
1111 S Glenstone Ave
Suite 3-100
Springfield, MO 65804-0338
Mailing address
1111 S Glenstone Ave
Suite 3-100
Springfield, MO 65804-0338
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 |
|---|---|---|---|
| 2004014918 | MO | MD | Professional Counselor |
| 2016038827 | MO | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542153600000",
"number": "1720435431",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 S GLENSTONE AVE",
"address_2": "SUITE 3-100",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658040338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 S GLENSTONE AVE",
"address_2": "SUITE 3-100",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658040338",
"telephone_number": "417-869-8911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONRAD",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-23",
"last_updated": "2018-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MO",
"license": "2016038827",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2004014918",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.