Healthcare Provider Details

I. General information

NPI: 1770751497
Provider Name (Legal Business Name): KIMBERLY ANNE MURPHY ACKERMAN ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 04/30/2023
Certification Date: 04/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5228 OUTRIGGER WAY
OXNARD CA
93035-1823
US

IV. Provider business mailing address

5228 OUTRIGGER WAY
OXNARD CA
93035-1823
US

V. Phone/Fax

Practice location:
  • Phone: 661-478-0844
  • Fax:
Mailing address:
  • Phone: 661-478-0844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number17532
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number613081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: