Basic Information
| Provider Information | |||||||||
| NPI: | 1104157742 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERMAN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3420 E SHEA BLVD STE 200266 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850283345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809776000 | ||||||||
| FaxNumber: | 2482690631 | ||||||||
| Practice Location | |||||||||
| Address1: | 3420 E SHEA BLVD STE 200266 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809776000 | ||||||||
| FaxNumber: | 2482690631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2010 | ||||||||
| LastUpdateDate: | 05/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP3504 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.