Kimberly Samantha Rodriguez, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

11415541-8900 Issued in UT

Practice address

395 W Cougar Blvd Ste 601
Provo, UT 84604-3331

Phone

(801) 357-7525

NPI assigned

Feb 26, 2026

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Samantha Rodriquez Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Meadowbrook Counseling of Utah LLC

  • Mental Health Counselor
  • Orem, UT
  • NPI 1225619737

  Psychiatric/Mental Health

  Medicare reassignment NPD

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

{
    "created_epoch": "1772064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788307200000",
    "number": "1992659767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 W COUGAR BLVD STE 601",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043331",
            "telephone_number": "801-357-7525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1433 N 1200 W",
            "address_purpose": "LOCATION",
            "city": "Orem",
            "state": "UT",
            "postal_code": "840572449",
            "country_code": "US",
            "telephone_number": "801-655-5450",
            "fax_number": "385-225-9327",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "508 W 700 S",
            "address_purpose": "LOCATION",
            "city": "Payson",
            "state": "UT",
            "postal_code": "846512735",
            "country_code": "US",
            "telephone_number": "801-472-9850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "KIMBERLY",
        "middle_name": "SAMANTHA",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-02-26",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "UT",
            "license": "11415541-8900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io.8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "RODRIQUEZ",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jeremy Dylan Rodgers, MASTER'S STUDENT
• Haylee Rodier
• Miguel Enrique Rodriguez-Cortes
• Carlos Rodriguez
• Kelly Rodriguez
• Leslie Katherine Bush Rodriguez, SSW
• Mary Rodriguez
• Nereida Rodriguez, RN
• Ricardo Israel Rodriguez
• Allan Roe, PH.D.

• Psychiatric/Mental Health Nurse Practitioner in Provo, UT
• Providers in Provo, UT by specialty
• Psychiatric/Mental Health Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.