Healthcare Provider Details

I. General information

NPI: 1235065210
Provider Name (Legal Business Name): KIMBERLY UNDERWOOD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIM UNDERWOOD RN

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 E LOWELL ST
TUCSON AZ
85721-0095
US

IV. Provider business mailing address

330 E LAS MILPAS
GREEN VALLEY AZ
85614-2916
US

V. Phone/Fax

Practice location:
  • Phone: 520-621-6493
  • Fax:
Mailing address:
  • Phone: 812-325-1463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number28129402C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: