Provider Demographics
NPI:1174776173
Name:ROBERTS, KIMBERLEY JEAN (WHNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:JEAN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 W THOMAS RD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3328
Mailing Address - Country:US
Mailing Address - Phone:623-936-1780
Mailing Address - Fax:623-936-9116
Practice Address - Street 1:9305 W THOMAS RD
Practice Address - Street 2:SUITE 155
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3328
Practice Address - Country:US
Practice Address - Phone:623-936-1780
Practice Address - Fax:623-936-9116
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2825363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ143364OtherMEDICARE PTAN