Active NPI
Kimberly R Smith, M.A. CCC-SLP
- Speech-Language Pathologist
- Key West, FL
National Provider Identifier
1790824860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA 11616
- Practice address
- 3641 Northside CT
Key West, FL 33040-4258 - Phone
- (305) 393-4277
- Fax
- (305) 292-4783
- NPI assigned
- Feb 6, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | SA11616 | FL | |
| Speech-Language Pathologist | 235Z00000X | HO451A | FL | |
| Speech-Language Pathologist | 235Z00000X | 010607-1 | NY | |
| Speech-Language Pathologist | 235Z00000X | SA 11616 | FL | Primary |
Addresses
Primary practice location
3641 Northside CT
Key West, FL 33040-4258
Mailing address
3641 Northside CT
Key West, FL 33040-4258
Phone (305) 393-4277
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HO451A | Other | FL | MEDICARE PART B |
| 09126830 | Other | ASHA CERTIFICATION NUMBER | |
| 010607-1 | Other | NY | NEW YORK STATE LICENSE # |
| SA 11616 | Other | FL | STATE OF FLORIDA DEPARTMENT OF HEALTH LICENSE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010607-1 | NY | MD | Emergency Medical Services (Emergency Medicine) Physician |
| HO451A | FL | MD | Speech-Language Pathologist |
| SA 11616 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502409600000",
"number": "1790824860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3641 NORTHSIDE CT",
"city": "KEY WEST",
"state": "FL",
"postal_code": "330404258",
"telephone_number": "305-393-4277",
"fax_number": "305-292-4783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3641 NORTHSIDE CT",
"city": "KEY WEST",
"state": "FL",
"postal_code": "330404258",
"telephone_number": "305-393-4277",
"fax_number": "305-292-4783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "KIMBERLY",
"middle_name": "R",
"name_prefix": "Mrs.",
"credential": "M.A. CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-06",
"last_updated": "2017-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "FL",
"license": "SA11616",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "HO451A",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "010607-1",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA 11616",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PART B",
"identifier": "HO451A",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASHA CERTIFICATION NUMBER",
"identifier": "09126830",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK STATE LICENSE #",
"identifier": "010607-1",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF FLORIDA DEPARTMENT OF HEALTH LICENSE #",
"identifier": "SA 11616",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Key West, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.