Individual provider Active NPI

Kimberly Jo Parks, M.A. CCC-SLP

  • Speech-Language Pathologist
  • San Angelo, TX
National Provider Identifier
1871615534
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
100231 Issued in TX
Practice address
120 E Harris Ave
San Angelo, TX 76903-5904
Phone
(325) 653-6741
NPI assigned
Apr 4, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 100231 TX Primary

Addresses

Primary practice location

120 E Harris Ave
San Angelo, TX 76903-5904

Mailing address

1218 Pecos St
San Angelo, TX 76901-3344
Phone (325) 653-1058

Other identifiers 1

IdentifierTypeStateIssuer
100231OtherTXSPEECH-LANGUAGE PATHOLOGY

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)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
100231TXMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871615534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1218 PECOS ST",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769013344",
            "telephone_number": "325-653-1058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 E HARRIS AVE",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769035904",
            "telephone_number": "325-653-6741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKS",
        "first_name": "KIMBERLY",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "M.A. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "100231",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPEECH-LANGUAGE PATHOLOGY",
            "identifier": "100231",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Angelo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.