Active NPI
Kimberly Elaine Komon, PHD
- Clinical Psychologist
- Southlake, TX
National Provider Identifier
1972385615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 34352
- Practice address
- 502 N Carroll Ave Ste 120
Southlake, TX 76092-6449 - Phone
- (682) 292-7012
- NPI assigned
- Oct 17, 2023
- Last updated
- Oct 17, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 33548 | TX | |
| Clinical Psychologist | 103TC0700X | 34352 | TX | Primary |
Addresses
Primary practice location
502 N Carroll Ave Ste 120
Southlake, TX 76092-6449
Mailing address
1012 Broken Wheel TRL
Aubrey, TX 76227-1284
Phone (972) 971-9824
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33548 | TX | MD | School Psychologist |
| 34352 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1697500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697500800000",
"number": "1972385615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1012 BROKEN WHEEL TRL",
"city": "AUBREY",
"state": "TX",
"postal_code": "762271284",
"telephone_number": "972-971-9824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "502 N CARROLL AVE STE 120",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "760926449",
"telephone_number": "682-292-7012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOMON",
"first_name": "KIMBERLY",
"middle_name": "ELAINE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-10-17",
"last_updated": "2023-10-17",
"certification_date": "2023-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "TX",
"license": "33548",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "34352",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southlake, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.