MEDICARE: ZENSIBLE PSYCHIATRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1700504370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZENSIBLE PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	2550 W UNION HILLS DR STE 350-1235
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-5163
Country	:	US
Telephone Number	:	623-866-7003
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 W UNION HILLS DR STE 350-1235
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-5163
Country	:	US
Telephone Number	:	623-866-7003
Fax Number	:

Authorized Official
Title or Position	:	OWNER/EMPLOYEE
Name	:	KIMBERLY A KUOPUS
Credential	:	PMHNP-BC
Telephone Number	:	906-361-4337

Provider Enumeration Date	:	08/18/2022
Last Update Date	:	08/18/2022

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