Kimberly Kay Beverly, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4007045 Issued in KY

Practice address

10331 Champion Farms Dr
Louisville, KY 40241-6129

Phone

(216) 468-5000

Fax

(216) 456-8128

NPI assigned

Aug 2, 2019

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

• Mrs. Kimberly Kay Burress Former name

Medicare fee-for-service enrollment

Enrolled in IN, KY2 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 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Centerstone of Indiana, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bloomington, IN
  • NPI 1992781470
  Medicare reassignment NPD
• State of Indiana, Auditor of State

  dba Madison State Hospital

  • Psychiatric Hospital
  • Madison, IN
  • NPI 1700876224
  Medicare reassignment NPD
• Baptist Health Medical Group Inc

  • Urgent Care Clinic/Center
  • Louisville, KY
  • NPI 1508269200

  IN

  Medicare reassignment
• Baptist Health Medical Group Inc

  • Nurse Practitioner
  • Lexington, KY
  • NPI 1518360296
  Medicare reassignment
• Centerstone of Indiana, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bloomington, IN
  • NPI 1972320224
  NPD
• State of Indiana, Auditor of State

  dba Indiana Department of Health

  • Public Health or Welfare Agency
  • Indianapolis, IN
  • NPI 1023613403
  NPD
• State of Indiana, Auditor of State

  dba Madison State Hospital

  • Psychiatric Hospital
  • Madison, IN
  • NPI 1659497477
  NPD

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

{
    "created_epoch": "1564704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697155200000",
    "number": "1740835164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2904 N RYKERS RIDGE RD",
            "city": "MADISON",
            "state": "IN",
            "postal_code": "472507648",
            "telephone_number": "812-701-1591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10331 CHAMPION FARMS DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402416129",
            "telephone_number": "216-468-5000",
            "fax_number": "216-456-8128"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "711 Green Rd",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "IN",
            "postal_code": "472502143",
            "country_code": "US",
            "telephone_number": "812-265-2611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEVERLY",
        "first_name": "KIMBERLY",
        "middle_name": "KAY",
        "name_prefix": "Mrs.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-02",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KY",
            "license": "4007045",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "28134347A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "BURRESS",
            "middle_name": "KAY",
            "prefix": "MRS.",
            "credential": "RN, BSN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kelly Betz, APRN
• Pamela L Beury, PT
• Beutifull Remedi, LLC
• Beverly J Bleidt PHD LLC
• Beverly M Gaines, MD & Associates, PSC
• Nikki Taylor Bevilacqua, DDS
• John Kirtley Beville, RPH
• Heather Bevins
• Bewley Inc
• Sarah Bewley

• Psychiatric/Mental Health Nurse Practitioner in Louisville, KY
• Providers in Louisville, KY by specialty
• Psychiatric/Mental Health Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.