Healthcare Provider Details

I. General information

NPI: 1568795482
Provider Name (Legal Business Name): KIMBERLY A OWENS-SMITH FNP-C, PMHNP-BC,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 E BASELINE RD STE 133
PHOENIX AZ
85042-7090
US

IV. Provider business mailing address

261 N ROOSEVELT AVE
CHANDLER AZ
85226-2617
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-8282
  • Fax: 844-470-2777
Mailing address:
  • Phone: 480-677-8282
  • Fax: 844-470-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number292149
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number292149
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: