Healthcare Provider Details

I. General information

NPI: 1689140386
Provider Name (Legal Business Name): KRISTIN NICOLE STARK MSN, CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN NICOLE CHAMBERS RN

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6678 W THUNDERBIRD RD
GLENDALE AZ
85306-3721
US

IV. Provider business mailing address

3003 N CENTRAL AVE STE 1600
PHOENIX AZ
85012-2908
US

V. Phone/Fax

Practice location:
  • Phone: 602-978-1500
  • Fax: 602-978-8944
Mailing address:
  • Phone: 602-323-3344
  • Fax: 602-323-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number218557
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number218557
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: