Kimberly Smith Bradshaw, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

15704 Issued in LA

Practice address

2503 Bonnie Ave
Bastrop, LA 71220-4173

Phone

(318) 516-4065

NPI assigned

Oct 22, 2015

Last updated

Dec 30, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Palmetto Addiction Recovery Center, Inc

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  • NPI 1982794962
  NPD (past)

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

{
    "created_epoch": "1445472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672358400000",
    "number": "1952773574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2503 BONNIE AVE",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712204173",
            "telephone_number": "318-516-4065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2503 BONNIE AVE",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712204173",
            "telephone_number": "318-516-4065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADSHAW",
        "first_name": "KIMBERLY",
        "middle_name": "SMITH",
        "name_prefix": "Mrs.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-22",
        "last_updated": "2022-12-30",
        "certification_date": "2022-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "LA",
            "license": "15704",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "15704",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Body & Soul Services, Inc.
• Body & Soul Services, Inc.
• Body & Soul Services,Inc
• Tracy Booker
• Camron Boston
• Victoria Renea Bradshaw, RN
• Brakefield & Co LLC
• Rena Marie Braswell, RN, FNP
• Caroline H Brockman, FNP
• Broken Wings Recovery Center, LLC (Broken Wings Recovery Center)

• Social Worker in Bastrop, LA
• Providers in Bastrop, LA by specialty
• Social Worker in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; 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.