Healthcare Provider Details

I. General information

NPI: 1790609063
Provider Name (Legal Business Name): KIMBERLEY MORITZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HIGHWAY 89 NORTH
PRESCOTT AZ
86313
US

IV. Provider business mailing address

1511 E YORKSHIRE AVE
CHINO VALLEY AZ
86323-7147
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-4860
  • Fax:
Mailing address:
  • Phone: 928-830-6985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342919
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: