Kimberly Renee Wilson-Lewis, PHD/CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

6628 Issued in TN

Practice address

462 Breckenridge Trce
Kingsport, TN 37663-2988

Phone

(615) 669-6418

NPI assigned

Mar 10, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• The Practical Clinician PLLC

  • Speech-Language Pathologist
  • Kingsport, TN
  • NPI 1902497340
  NPD Authorized official

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

{
    "created_epoch": "1425945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1770976144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "462 BRECKENRIDGE TRCE",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376632988",
            "telephone_number": "615-669-6418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "462 BRECKENRIDGE TRCE",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376632988",
            "telephone_number": "615-669-6418"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "572 Preserve Park Dr",
            "address_purpose": "LOCATION",
            "city": "Loganville",
            "state": "GA",
            "postal_code": "300525872",
            "country_code": "US",
            "telephone_number": "678-667-4650",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "156 S. Dossett Drive",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "37614",
            "country_code": "US",
            "telephone_number": "423-439-4355",
            "fax_number": "423-439-4607",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "156 S. Dossett Drive",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "37614",
            "country_code": "US",
            "telephone_number": "423-439-4355",
            "fax_number": "423-439-4607",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON-LEWIS",
        "first_name": "KIMBERLY",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "PHD/CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-10",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP006884",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TN",
            "license": "6628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q048423",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "simplepractice.com",
            "affiliation": "N",
            "endpointDescription": "HIPAA Compliant practice website",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "treatment/eval notes",
            "address_1": "462 Breckenridge Trce",
            "city": "Kingsport",
            "state": "TN",
            "country_code": "US",
            "postal_code": "376632988",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Katrina Kaye Willingham, RN
• Bradley Willis
• Gregg A Willis, MD
• Michael Willis, D.P.M.
• Christy Willocks, FNP
• Bill Earl Wilson, DPH
• Gary G Wilson, M.D.
• Michelle Wilson, FNP
• Patricia J Wilson, CNM
• Sarah Wilson

• Speech-Language Pathologist in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Speech-Language Pathologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; 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.