Kimberly S Squires, FNP-C; PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

2014029878 Issued in NC

Practice address

10320 Mallard Creek Rd
Ste 240
Charlotte, NC 28262-9756

Phone

(704) 886-8703

NPI assigned

Apr 2, 2009

Last updated

Jul 22, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Riverside Physician Services Inc

  dba Riverside Gastroenterology Specialists

  • Gastroenterology Physician
  • Newport News, VA
  • NPI 1194929026
  Medicare reassignment NPD
• Western Tidewater Community Mental

  dba Western Tidewater Community Services Board

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Suffolk, VA
  • NPI 1689615296
  Medicare reassignment NPD
• Riverside Physician Services Inc

  dba Riverside Gastroenterology Specialists Williamsburg

  • Gastroenterology Physician
  • Williamsburg, VA
  • NPI 1083867311
  NPD
• Riverside Physician Services, Inc.

  • Family Medicine Physician
  • Newport News, VA
  • NPI 1710020623
  NPD
• Andrea Hope Speech Pathology LLC

  • Speech-Language Pathologist
  • Rock Hill, SC
  • NPI 1942568829
  NPD (past)
• Jewell Family and Elder Medicine PA

  • Geriatric Medicine (Family Medicine) Physician
  • Rock Hill, SC
  • NPI 1215982533

  Nurse Practitioner

  NPD (past)

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

{
    "created_epoch": "1238630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469145600000",
    "number": "1871735068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10320 MALLARD CREEK RD",
            "address_2": "STE 240",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282629756",
            "telephone_number": "704-886-8703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10320 MALLARD CREEK RD",
            "address_2": "STE 240",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282629756",
            "telephone_number": "704-886-8703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SQUIRES",
        "first_name": "KIMBERLY",
        "middle_name": "S",
        "credential": "FNP-C; PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-02",
        "last_updated": "2016-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "218478",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "2008001301",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "2014029878",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ETN P97980",
            "identifier": "5004974",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katelyn Celia Spurlin
• Michelle Monroe Spurlock, PHARM.D.
• Eva Foegeding Squibb, FNP-BC
• Bianca Squillante, PHARMD
• Jennifer Crutchfield Squires, M.D.
• Malcolm Hart Squires III, MD
• Rebekah Squires, PHD
• Harley Squittieri
• Keri Anne Squittieri, PA-C
• Jacqueline Annette Sroka, NP-C

• Psychiatric/Mental Health Nurse Practitioner in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.