Healthcare Provider Details

I. General information

NPI: 1447038922
Provider Name (Legal Business Name): KIMBERLY JOY HEATH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1247 KAAHUMANU ST STE 116
AIEA HI
96701-5300
US

IV. Provider business mailing address

2912 W ALTADENA AVE
PHOENIX AZ
85029-4325
US

V. Phone/Fax

Practice location:
  • Phone: 808-762-0911
  • Fax:
Mailing address:
  • Phone: 407-212-2543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95032810
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-5159
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number848913
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number848913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: