Healthcare Provider Details

I. General information

NPI: 1366372278
Provider Name (Legal Business Name): KIMBERLY GRAY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 E FORT LOWELL RD STE 131
TUCSON AZ
85712-1183
US

IV. Provider business mailing address

12171 W CHARISMATIC DR
MARANA AZ
85653-1079
US

V. Phone/Fax

Practice location:
  • Phone: 520-396-4413
  • Fax:
Mailing address:
  • Phone: 313-806-3751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number262368
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: