Healthcare Provider Details

I. General information

NPI: 1760249247
Provider Name (Legal Business Name): KIMBERLY JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 E HUNT HWY STE 105
SAN TAN VALLEY AZ
85143-5096
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: 888-316-1686
Mailing address:
  • Phone: 480-677-8282
  • Fax: 888-316-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number304896
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: