Kimberly Dawn Mitcham, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN149433NP Issued in GA

Practice address

950 S Main St Ste 2
Baxley, GA 31513-0161

Phone

(912) 367-2596

Fax

(912) 367-8706

NPI assigned

Nov 5, 2015

Last updated

Jan 20, 2023By 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

Medicare fee-for-service enrollment

Enrolled in GA, TX, AK3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Diversity Health Center IncGroup PAC ID 9638261910, 12 clinicians

Great Plains Tribal Chairmen's Health BoardGroup PAC ID 0648609917, 64 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimberly.mitcham.1@29855.direct.athenahealth.com

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.

• Diversity Health Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Hinesville, GA
  • NPI 1326594714
  Medicare reassignment Care Compare group NPD
• Great Plains Tribal Chairmen's Health Board

  dba Oyate Health Center

  • Pharmacy
  • Rapid City, SD
  • NPI 1376105452

  TX

  Medicare reassignment Care Compare group NPD
• Alaska Native Tribal Health Consortium

  • General Acute Care Hospital
  • Anchorage, AK
  • NPI 1437189339

  TX

  Medicare reassignment NPD
• Seward Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Seward, AK
  • NPI 1356772024
  Medicare reassignment NPD
• Southcentral Foundation

  dba BSD - McGrath

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • McGrath, AK
  • NPI 1780614263

  TX

  Medicare reassignment NPD
• Diversity Health Center Inc.

  • Community/Retail Pharmacy
  • Ludowici, GA
  • NPI 1265274120
  NPD
• Diversity Health Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Jesup, GA
  • NPI 1518508613
  NPD
• Southcentral Foundation

  dba Tribal- ANPCC- NRS Home visit

  • Primary Care Clinic/Center
  • Anchorage, AK
  • NPI 1437772886
  NPD

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

{
    "created_epoch": "1446681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674172800000",
    "number": "1720451297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 S MAIN ST STE 2",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315130161",
            "telephone_number": "912-367-2596",
            "fax_number": "912-367-8706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 S MAIN ST STE 2",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315130161",
            "telephone_number": "912-367-2596",
            "fax_number": "912-367-8706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHAM",
        "first_name": "KIMBERLY",
        "middle_name": "DAWN",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-05",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN149433NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Kathryn McMahan, MD
• Patricia Dale McTier, RN
• McTwynn, Inc (Lakeview Retirement Center)
• Marley Mikell Melton, OTR/L
• Heather Strickland Miller, PA-C
• Gerry Delayne Moore Sr.
• Crystal Nicole Moran
• Jessica Morris, PHARMD
• Michael Glenn Moss, MD
• Neal Lovett, OD, LLC

• Family Nurse Practitioner in Baxley, GA
• Providers in Baxley, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.