Provider Demographics
NPI:1568795482
Name:OWENS-SMITH, KIMBERLY A (FNP-C, PMHNP-BC,)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:OWENS-SMITH
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 N ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2617
Mailing Address - Country:US
Mailing Address - Phone:480-677-8282
Mailing Address - Fax:844-470-2777
Practice Address - Street 1:2445 E BASELINE RD STE 133
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-7090
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:844-470-2777
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ292149363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ204723Medicaid