Healthcare Provider Details

I. General information

NPI: 1386456325
Provider Name (Legal Business Name): KIMBERLY A LADZEKPO FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E PALMDALE BLVD
PALMDALE CA
93550-4598
US

IV. Provider business mailing address

9100 N CENTRAL AVE STE C
PHOENIX AZ
85020-2430
US

V. Phone/Fax

Practice location:
  • Phone: 818-654-3887
  • Fax:
Mailing address:
  • Phone: 818-873-9984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number326053
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1115000
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033512
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number326053
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1115000
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95033512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: