Celesta Kimble

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A-1179 Issued in NV

Practice address

1409 E Lake Mead Blvd
North Las Vegas, NV 89030-7120

Phone

(702) 649-7711

NPI assigned

Sep 17, 2021

Last updated

Sep 17, 2021By 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 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1962172338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9303 GILCREASE AVE UNIT 1141",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891496110",
            "telephone_number": "708-374-4451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 E LAKE MEAD BLVD",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890307120",
            "telephone_number": "702-649-7711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBLE",
        "first_name": "CELESTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-17",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NV",
            "license": "A-1179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000000000",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Celesta_kimble2@yahoo.com",
            "affiliation": "N",
            "address_1": "1409 E Lake Mead Blvd",
            "city": "North Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "890307120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jun Chong Kim, DO
• Priscilla Kim, DO
• Sharon Mia Kim, D.D.S., M.S.
• Sion Kim, MD
• Yu NA Kim
• Stacy Louise Kimbrough
• Christine Yuri Kimura, PHARM.D.
• Sandra Valdez Kimura
• Daniela Kin, MD
• Israel M Kin, P.A

• Physical Therapy Assistant in North Las Vegas, NV
• Providers in North Las Vegas, NV by specialty
• Physical Therapy Assistant in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.