Healthcare Provider Details

I. General information

NPI: 1255690483
Provider Name (Legal Business Name): KIMBERLY E DYER F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W ORANGE GROVE RD STE 416
TUCSON AZ
85704-1141
US

IV. Provider business mailing address

2001 W ORANGE GROVE RD STE 416
TUCSON AZ
85704-1141
US

V. Phone/Fax

Practice location:
  • Phone: 520-888-3032
  • Fax: 800-330-0592
Mailing address:
  • Phone: 520-888-3032
  • Fax: 800-330-0592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4473
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN127606
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: