Healthcare Provider Details

I. General information

NPI: 1285112615
Provider Name (Legal Business Name): KIMBRELLE ANNE PASCUA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2018
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 VISTA LN
CARSON CITY NV
89703-4643
US

IV. Provider business mailing address

1385 VISTA LN
CARSON CITY NV
89703-4643
US

V. Phone/Fax

Practice location:
  • Phone: 775-884-4567
  • Fax: 775-884-4569
Mailing address:
  • Phone: 775-884-4567
  • Fax: 775-884-4569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number811217
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: