Healthcare Provider Details

I. General information

NPI: 1689143778
Provider Name (Legal Business Name): KIMBERLY ANNE SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11209 N TATUM BLVD STE 255
PHOENIX AZ
85028-6061
US

IV. Provider business mailing address

2424 N WYATT DR STE 260
TUCSON AZ
85712-6118
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-5050
  • Fax:
Mailing address:
  • Phone: 520-795-0549
  • Fax: 520-795-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number299520
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: