Kimberly Fowler, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6216 Issued in TN

Practice address

170 Smithfield Dr
Jackson, TN 38305-1817

Phone

(731) 300-1117

NPI assigned

Jan 27, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kimberly Graham Former name

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ultra Health LLC 151 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14578/brand/1/csg/1/fhir/r4

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.

• Ultra Health LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Nashville, TN
  • NPI 1922469543

  Clinical, TN

  Medicare reassignment Care Compare group NPD
• Impact Behavioral Counseling LLC

  • Addiction (Substance Use Disorder) Counselor
  • Jackson, TN
  • NPI 1386169050

  Clinical, TN

  Medicare reassignment NPD
• Ultra Health Providers II LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Nashville, TN
  • NPI 1033956057

  TN

  Medicare reassignment
• Impact Healthcare, PLLC

  • Addiction Medicine (Family Medicine) Physician
  • Jackson, TN
  • NPI 1487185153
  NPD (past)
• Eagles Nest of Gastonia

  • Community/Behavioral Health Agency
  • Gastonia, NC
  • NPI 1750652301
  NPD (past)

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

{
    "created_epoch": "1169856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1831245166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 URBAN CENTER DR STE 600",
            "city": "VESTAVIA",
            "state": "AL",
            "postal_code": "352422584",
            "telephone_number": "205-208-9312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 SMITHFIELD DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383051817",
            "telephone_number": "731-300-1117"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1804 Highway 45 Byp",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "TN",
            "postal_code": "383054436",
            "country_code": "US",
            "telephone_number": "731-935-8200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "104 Cude Ln Ste 168",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "TN",
            "postal_code": "371152202",
            "country_code": "US",
            "telephone_number": "615-868-9959",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1101 Fox Meadows Blvd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Sevierville",
            "state": "TN",
            "postal_code": "378626937",
            "country_code": "US",
            "telephone_number": "865-280-2700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "801 Hill St Ste B",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "TN",
            "postal_code": "371722951",
            "country_code": "US",
            "telephone_number": "615-382-3002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "KIMBERLY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-27",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "6216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "GRAHAM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mark W Foster, CRNA
• Fouche Psychological Services PLLC
• Joseph E Fouche, MD
• Sophia Fouche, PH.D
• Kalee Jo Fountain, FNP-C
• Melissa Fowler, MS
• Rex Wayne Fowler, DC
• Robert Douglas Fowler, MD
• Shelby Fowler, A.P.N
• Teresa Fowler, DNP

• All providers in Jackson, TN
• Clinical Social Worker in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.