Individual provider Active NPI

Kimberly Kaye Koehn, NP

  • Nurse Practitioner
  • Brenham, TX
National Provider Identifier
1730100686
Registry record updated Jan 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP107355 Issued in TX
Practice address
600 N Park St
Brenham, TX 77833-2610
Phone
(979) 337-5800
NPI assigned
Jul 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 540281 TX
Nurse Practitioner 363L00000X AP107355 TX Primary

Addresses

Primary practice location

600 N Park St
Brenham, TX 77833-2610

Mailing address

PO Box 844658
Dallas, TX 75284-4658

Other practice location 1

235 W Palm St Ste 105
Bellville, TX 77418-1300
Phone (979) 865-3124

Other identifiers 1

IdentifierTypeStateIssuer
209310601MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kkoehn47343@direct.sw.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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 1

Enrollment IDStateProvider typePAC IDDetails
I20070716000571 TX Practitioner - Nurse Practitioner 0749199685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Scott and White ClinicGroup PAC ID 8123923604, 2,426 clinicians

Practice addresses (Care Compare)

1280 Arrington Rd
Suite 200
College Station, TX 77845-8696
Phone (979) 207-6550

1605 S 31St St
Baylor Scott and White Center for Dia
Temple, TX 76508-0001
Phone (254) 215-0100

1700 University Dr E
College Station, TX 77840-2661
Phone (979) 691-3300

1700 University Dr E Entrance 16
Care Clinic College Station University Dr
College Station, TX 77840-2661
Phone (979) 207-3636

2111 S Day St
Baylor Scott and White Clinic Brenh
Brenham, TX 77833-5512
Phone (979) 830-5017

2401 S 31 St
Temple, TX 76508-0001
Phone (254) 724-2459

2401 S 31St St BLDG
35 Baylor Scott and White Roney Bone and
Temple, TX 76508-0001
Phone (254) 724-2663

604 Hwy 290 W
Baylor Scott and White Clinic Brenh
Brenham, TX 77833-5432
Phone (979) 337-5400

810 W U Ave
Temple, TX 76508-0001
Phone (254) 724-2585

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
540281TXMDNurse Practitioner
AP107355TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Scott & White Clinic Current Accepting new patients
Scott & White Clinic CurrentSince Aug 7, 2018 Accepting new patients
Scott & White Clinic CurrentSince Aug 7, 2018 Accepting new patients
Bellville Hospital District Past Accepting new patients
Scott & White Hospital - Taylor Past Accepting new patients

Locations

235 W Palm St
Ste 106
Bellville, TX 77418
Phone (979) 272-4156

600 N Park St
Brenham, TX 77833
Phone (409) 836-6153

2111 S Day St
Brenham, TX 77833
Phone (979) 830-5017

1280 Arrington Rd
Ste 200
College Station, TX 77845
Phone (979) 207-6550

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

Interoperability endpoints

  • Direct secure messaging: kkoehn47343@direct.sw.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1730100686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N PARK ST",
            "city": "BRENHAM",
            "state": "TX",
            "postal_code": "778332610",
            "telephone_number": "979-337-5800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "235 W Palm St Ste 105",
            "address_purpose": "LOCATION",
            "city": "Bellville",
            "state": "TX",
            "postal_code": "774181300",
            "country_code": "US",
            "telephone_number": "979-865-3124",
            "fax_number": "979-865-9193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOEHN",
        "first_name": "KIMBERLY",
        "middle_name": "KAYE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-23",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "540281",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP107355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209310601",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kkoehn47343@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "600 N Park St",
            "city": "Brenham",
            "state": "TX",
            "country_code": "US",
            "postal_code": "778332610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brenham, TX

Sources for this page

Verify at the official NPI Registry.