Healthcare Provider Details

I. General information

NPI: 1356246607
Provider Name (Legal Business Name): KIMBERLY HEARN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4374 EAST BUTTE AVENUE
FLORENCE AZ
85132
US

IV. Provider business mailing address

3027 N HAWTHORN DR
FLORENCE AZ
85132-6892
US

V. Phone/Fax

Practice location:
  • Phone: 205-536-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number298196
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: