KIMBERLY J. RANDALL CADC, CRM – NPI #1669991212
Peer Specialist

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

KIMBERLY RANDALL is a peer specialist located in PORTLAND, OR. NPPES has assigned the NPI number 1669991212 to KIMBERLY RANDALL on September 14, 2017. It is a Type-1 NPI, indicating this NPI number is associated with an individual. The primary taxonomy selected by this provider is 175T00000X from the Health Care Provider Taxonomy code set, which is classified as Peer Specialist.

The NPI profile was previously updated about 3 years ago on Aug 31, 2023. See the complete NPI profile for KIMBERLY RANDALL below.

NPI Profile for
KIMBERLY J. RANDALL

NPI Number
1669991212
Enumeration Date

(more than 8 years ago)
Entity Type
Type-1  Individual (Female)
Legal Name
KIMBERLY J. RANDALL
Credentials
CADC, CRM
Primary location
1030 NE COUCH ST
PORTLAND, OR 97232
Phone: (503) 239-8400 Fax: (503) 239-8406
1 Other location(s):
1027 E. Burnside St.
Portland, OR 97214
Phone: (503) 239-8400
Fax: (503) 239-8407
Mailing address
14600 NW CORNELL RD
PORTLAND, OR 97229-5442
Phone: (503) 645-3581 Fax: (503) 629-8517
Sole Proprietor
Yes
Updated
Certification Date
Aug 31, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for KIMBERLY RANDALL

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
medicaidORTHW1868
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
175T00000X
- Peer Specialist (Primary)
OR THW1868

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.