Active NPI
Kimberly V Dwyer, PH.D.
- Clinical Psychologist
- Greenwood Village, CO
National Provider Identifier
1992751721
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2530
- Practice address
- 5350 S Roslyn St Ste 306
Greenwood Village, CO 80111-2124 - Phone
- (303) 727-0146
- NPI assigned
- May 25, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 893 | WV | |
| Clinical Psychologist | 103TC0700X | 2530 | CO | Primary |
Addresses
Primary practice location
5350 S Roslyn St Ste 306
Greenwood Village, CO 80111-2124
Mailing address
5350 S Roslyn St Ste 306
Greenwood Village, CO 80111-2124
Phone (303) 727-0146
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810001632 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2023 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 893 | WV | MD | Psychologist |
| 2530 | CO | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Willow Ridge PLLC | Psychiatry | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Psychiatry Physician
- Lewisburg, WV
- NPI 1629241880
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266451200000",
"number": "1992751721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5350 S ROSLYN ST STE 306",
"city": "GREENWOOD VILLAGE",
"state": "CO",
"postal_code": "801112124",
"telephone_number": "303-727-0146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5350 S ROSLYN ST STE 306",
"city": "GREENWOOD VILLAGE",
"state": "CO",
"postal_code": "801112124",
"telephone_number": "303-727-0146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DWYER",
"first_name": "KIMBERLY",
"middle_name": "V",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-25",
"last_updated": "2010-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WV",
"license": "893",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "2530",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810001632",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenwood Village, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.