The Practical Clinician PLLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

THE PRACTICAL CLINICIAN PLLC

Practice address

462 Breckenridge Trce
Kingsport, TN 37663-2988

Phone

(678) 667-4650

NPI assigned

Jan 28, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Kimberly Renee Wilson-Lewis, PH.D.. , CCC-SLPNPI 1770976144

Title

Clinical Owner

Phone

(678) 667-4650

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberly Renee Wilson-Lewis, PHD/CCC-SLP

  • Speech-Language Pathologist
  • Kingsport, TN
  • NPI 1770976144
  NPD Authorized official

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

{
    "created_epoch": "1611792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611792000000",
    "number": "1902497340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "462 BRECKENRIDGE TRCE",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376632988",
            "telephone_number": "678-667-4650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "462 BRECKENRIDGE TRCE",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376632988",
            "telephone_number": "678-667-4650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PRACTICAL CLINICIAN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-28",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A",
        "authorized_official_last_name": "WILSON-LEWIS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CLINICAL OWNER",
        "authorized_official_telephone_number": "678-667-4650",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D.. , CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Speech-Language Pathologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; 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.