Healthcare Provider Details

I. General information

NPI: 1043320088
Provider Name (Legal Business Name): KIMBERLY ANN COUCH CNM, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/17/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 N 16TH ST
PHOENIX AZ
85016-5319
US

IV. Provider business mailing address

4212 N 16TH ST
PHOENIX AZ
85016-5319
US

V. Phone/Fax

Practice location:
  • Phone: 602-623-1511
  • Fax: 602-263-1637
Mailing address:
  • Phone: 602-623-1511
  • Fax: 602-263-1637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN071137
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP0237
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN071137
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP0237
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: