Healthcare Provider Details

I. General information

NPI: 1538022033
Provider Name (Legal Business Name): KIMBERLY DESEREE DENHAM PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4527 N 16TH ST STE 201
PHOENIX AZ
85016-5352
US

IV. Provider business mailing address

13234 W BERRIDGE LN
LITCHFIELD PARK AZ
85340-7308
US

V. Phone/Fax

Practice location:
  • Phone: 602-657-8462
  • Fax:
Mailing address:
  • Phone: 602-657-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number330310
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: