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General NPI Number Information
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NPI Number | 1518699479
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Entity Type | Individual
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Provider Name | KIMBERLY A MITCHELL FNP
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Gender | Female
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 18555 N 79TH AVE STE B108
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City | GLENDALE
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State | AZ
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Zip | 85308-8372
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Country | US
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Telephone | 888-705-8558
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Fax | 480-776-0025
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Provider Business Mailing Address
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Address Line | 2145 E BASELINE RD # 101
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City | TEMPE
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State | AZ
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Zip | 85283-1503
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Country | US
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Telephone | 888-705-8558
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Fax | 480-776-0025
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 277227
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License Number State | AZ
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