Active NPI
Kelle Gibbs
- Speech-Language Pathologist
- Maryville, TN
National Provider Identifier
1922400324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 5337
- Practice address
- 2030 Chilhowee Medical Park
Maryville, TN 37804-5285 - Phone
- (865) 982-3400
- Fax
- (865) 982-3410
- NPI assigned
- Sep 17, 2014
- 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 | 5337 | TN | Primary |
Addresses
Primary practice location
2030 Chilhowee Medical Park
Maryville, TN 37804-5285
Mailing address
9202 Shady Mill LN
Knoxville, TN 37922-4235
Phone (803) 463-8861
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q008611 | Medicaid | TN |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5337 | TN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Speech Pathology Services of East Tennessee LLC | Speech-Language Pathologist | Past | Accepting new patients |
| Little Tennessee Valley Educational Cooperative | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Local Education Agency (LEA)
- Loudon, TN
- NPI 1114256039
-
- Rehabilitation Clinic/Center
- Maryville, TN
- NPI 1659466712
Speech-Language Pathologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523232000000",
"number": "1922400324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9202 SHADY MILL LN",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379224235",
"telephone_number": "803-463-8861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2030 CHILHOWEE MEDICAL PARK",
"city": "MARYVILLE",
"state": "TN",
"postal_code": "378045285",
"telephone_number": "865-982-3400",
"fax_number": "865-982-3410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBBS",
"first_name": "KELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-17",
"last_updated": "2018-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TN",
"license": "5337",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Q008611",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maryville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.