Active NPI
Kimberly McCollum
- Women's Health Nurse Practitioner
- San Antonio, TX
National Provider Identifier
1922684364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Women's Health Nurse Practitioner
- License
- 818597
- Practice address
- 1202 E Sonterra Blvd Ste 102
San Antonio, TX 78258-4238 - Phone
- (210) 305-5075
- NPI assigned
- Mar 23, 2021
- 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 |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | 818597 | TX | Primary |
Addresses
Primary practice location
1202 E Sonterra Blvd Ste 102
San Antonio, TX 78258-4238
Mailing address
1202 E Sonterra Blvd Ste 102
San Antonio, TX 78258-4238
Phone (210) 305-5075
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Previously, effective Aug 28, 2024 through Aug 28, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 818597 | TX | MD | Women's Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634515200000",
"number": "1922684364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1202 E SONTERRA BLVD STE 102",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782584238",
"telephone_number": "210-305-5075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1202 E SONTERRA BLVD STE 102",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782584238",
"telephone_number": "210-305-5075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCOLLUM",
"first_name": "KIMBERLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-23",
"last_updated": "2021-10-18",
"certification_date": "2021-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LW0102X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Women's Health",
"state": "TX",
"license": "818597",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2021; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.