Healthcare Provider Details

I. General information

NPI: 1235119421
Provider Name (Legal Business Name): KIMBERLY ANN ECKLEY WHC NP RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 S CORONADO DR STE A
SIERRA VISTA AZ
85635-6356
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 520-545-0676
  • Fax: 520-547-2993
Mailing address:
  • Phone: 520-795-0608
  • Fax: 520-795-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN149791
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP2960
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP2960
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: