Active NPI
Kimberly Ann Vidrine, M.S., CCC-SLP
- Speech-Language Pathologist
- Lake Charles, LA
National Provider Identifier
1891826798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 4427
- Practice address
- 227 Heather St
Lake Charles, LA 70605-6505 - Phone
- (337) 479-2382
- NPI assigned
- Mar 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 4427 | LA | Primary |
Addresses
Primary practice location
227 Heather St
Lake Charles, LA 70605-6505
Mailing address
227 Heather St
Lake Charles, LA 70605-6505
Phone (337) 479-2382
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1308188 | Medicaid | LA |
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 Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4427 | LA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1891826798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "227 HEATHER ST",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706056505",
"telephone_number": "337-479-2382"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "227 HEATHER ST",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706056505",
"telephone_number": "337-479-2382"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIDRINE",
"first_name": "KIMBERLY",
"middle_name": "ANN",
"name_prefix": "Miss",
"credential": "M.S., CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-09",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "LA",
"license": "4427",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1308188",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.