Kimberly Smith, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

1101 W Clay Rd
Versailles, MO 65084-1177

Phone

(573) 280-3321

Fax

(573) 539-3066

NPI assigned

Jan 7, 2019

Last updated

Jan 7, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Kim Smith Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1546819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546819200000",
    "number": "1730652355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1682 CUP TREE RD",
            "city": "GRAVOIS MILLS",
            "state": "MO",
            "postal_code": "650376930",
            "telephone_number": "573-280-3321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 W CLAY RD",
            "city": "VERSAILLES",
            "state": "MO",
            "postal_code": "650841177",
            "telephone_number": "573-280-3321",
            "fax_number": "573-539-3066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KIMBERLY",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-07",
        "last_updated": "2019-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2006038459",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "SMITH",
            "credential": "PTA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Sharon Lynn Shepherd, ACNS
• Amanda Kay Shipp, M.D.
• Darrell James Shirk
• Amy L Smith, RPH
• Erin Michelle Smith
• Charlisa Martrell Stark, PLPC
• Seanna Paige Stevenson, NP-C
• Ida Mae Suttmoller, MA LCSW CASAC
• Erin Svoboda
• Dawn Teschner

• Physical Therapy Assistant in Versailles, MO
• Providers in Versailles, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.