MEDICARE: KIMBERLY HARSHBERGER WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	AP5104	AZ

General Provider Information

NPI Number	:	1124460027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY HARSHBERGER WHNP

Provider Business Mailing Address
First Line	:	4751 N 15TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-3707
Country	:	US
Telephone Number	:	623-934-7006
Fax Number	:	623-937-3014

Provider Business Practice Location Address
First Line	:	4751 N 15TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-3707
Country	:	US
Telephone Number	:	623-934-7006
Fax Number	:	623-937-3014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	03/06/2019

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