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General NPI Number Information
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NPI Number | 1063024909
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Entity Type | Individual
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Provider Name | KIMBERLY DAWN YAZZIE
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Gender | Female
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 4041 N CENTRAL AVE BLDG C
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City | PHOENIX
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State | AZ
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Zip | 85012-3313
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Country | US
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Telephone | 602-279-5262
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Fax |
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Provider Business Mailing Address
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Address Line | 12910 W SOLEDAD ST
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City | EL MIRAGE
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State | AZ
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Zip | 85335-5375
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Country | US
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Telephone | 602-354-1149
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 313755
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN165975
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License Number State | AZ
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