Healthcare Provider Details

I. General information

NPI: 1861112658
Provider Name (Legal Business Name): KIMBERLYN JOY CARTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLYN JOY NAGEL NP

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 WILLOW CREEK RD
PRESCOTT AZ
86301-1641
US

IV. Provider business mailing address

PO BOX 967
FLAGSTAFF AZ
86002-0967
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-0003
  • Fax: 928-773-1170
Mailing address:
  • Phone: 928-773-0003
  • Fax: 928-773-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number280152
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number280152
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: