Healthcare Provider Details

I. General information

NPI: 1578749966
Provider Name (Legal Business Name): BETH ANN KIMPSON NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH PELZER

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 CHILDRENS WAY
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

3020 CHILDRENS WAY # MC5008
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-5818
  • Fax:
Mailing address:
  • Phone: 858-966-5818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number110747
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberNP95006409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: