Basic Information
| Provider Information | |||||||||
| NPI: | 1982780474 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIMES | ||||||||
| FirstName: | RACHAEL | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8041 N BLACK CANYON HWY STE I | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850214173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022490115 | ||||||||
| FaxNumber: | 6022460837 | ||||||||
| Practice Location | |||||||||
| Address1: | 8041 N BLACK CANYON HWY STE I | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850214173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022490115 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 06/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN124138 | AZ | N | Nursing Service Providers | Registered Nurse | 363LA2100X | AP2560 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.