Kimberly Rey, NURSE PRACTITIONER

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

95025251 Issued in CA

Practice address

11801 Go for Broke Rd
Roseville, CA 95678-7055

Phone

(916) 409-8262

NPI assigned

Jul 5, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

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.

• Ethos Care Management

  • Internal Medicine Physician
  • Long Beach, CA
  • NPI 1720961139
  Medicare reassignment NPD
• Native Health, a Professional Nursing Corporation

  • Nursing Care Agency
  • Roseville, CA
  • NPI 1306725510
  NPD Authorized official

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

{
    "created_epoch": "1688515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1841978368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9148",
            "city": "AUBURN",
            "state": "CA",
            "postal_code": "956049148",
            "telephone_number": "619-565-9137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11801 GO FOR BROKE RD",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956787055",
            "telephone_number": "916-409-8262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REY",
        "first_name": "KIMBERLY",
        "name_prefix": "Ms.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-05",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "95025251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Connie L Revecamp, M.S.
• Santa Liliana Revelez
• Isreal Revivo
• Thomas Kelly Rexinger, CRNA
• Rebecca Rexroat, HAD #8451
• Daniel Fernando Reyes Sighinolfi, DDS
• Anthony Reyes, LMFT
• Cristine Gail Soriano Reyes I
• Florita Reyes, PA
• Jai Reyes

• Primary Care Nurse Practitioner in Roseville, CA
• Providers in Roseville, CA by specialty
• Primary Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.
• 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.