Healthcare Provider Details

I. General information

NPI: 1245937960
Provider Name (Legal Business Name): KIMBERLY HA BOWER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 W THOMAS RD STE 155
PHOENIX AZ
85037-0910
US

IV. Provider business mailing address

1661 E CAMELBACK RD STE 200
PHOENIX AZ
85016-3913
US

V. Phone/Fax

Practice location:
  • Phone: 623-936-1780
  • Fax:
Mailing address:
  • Phone: 602-422-9000
  • Fax: 602-556-5951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number286094
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number286094
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: