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KIMBERLY KELLY
Complete NPI Record 1285208058
Behavior Technician in Pemberton, NJ

NPI Status: Active since May 17, 2021

Contact Information

43 ELIZABETH ST
PEMBERTON, NJ
ZIP 08068
Phone: (609) 316-0195

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider First Line Business Practice Location Address
  11. Provider Business Practice Location Address City Name
  12. Provider Business Practice Location Address State Name
  13. Provider Business Practice Location Address Postal Code
  14. Provider Business Practice Location Address Country Code If outside U S
  15. Provider Business Practice Location Address Telephone Number
  16. Provider Enumeration Date
  17. Last Update Date
  18. Provider Gender Code
  19. Healthcare Provider Taxonomy Code 1
  20. Provider License Number 1
  21. Provider License Number State Code 1
  22. Healthcare Provider Primary Taxonomy Switch 1
  23. Is Sole Proprietor
  24. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1285208058. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1285208058
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider First Name: KIMBERLY
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: PO BOX 253
Other name by which the organization provider is or has been known.
Provider Business Mailing Address City Name: SKILLMAN
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider Business Mailing Address State Name: NJ
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address Postal Code: 085580253
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address Country Code If outside U S : US
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider First Line Business Practice Location Address: 43 ELIZABETH ST
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Practice Location Address City Name: PEMBERTON
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Practice Location Address State Name: NJ
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address Postal Code: 080681232
The city name in the location address of the provider being identified.
Provider Business Practice Location Address Country Code If outside U S : US
The State code in the location of the provider being identified.
Provider Business Practice Location Address Telephone Number: 6093160195
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Enumeration Date: 5/17/2021
The country code in the location address of the provider being identified.
Last Update Date: 5/17/2021
The telephone number associated with the location address of the provider being identified.
Provider Gender Code: F
The fax number associated with the location address of the provider being identified.
Healthcare Provider Taxonomy Code 1: 106S00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: RBT-21-167928
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: NJ
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date: 5/17/2021