Provider Demographics
NPI:1043320088
Name:COUCH, KIMBERLY ANN (CNM, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:COUCH
Suffix:
Gender:F
Credentials:CNM, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5319
Mailing Address - Country:US
Mailing Address - Phone:602-623-1511
Mailing Address - Fax:602-263-1637
Practice Address - Street 1:4212 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5319
Practice Address - Country:US
Practice Address - Phone:602-623-1511
Practice Address - Fax:602-263-1637
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN071137163WM0102X, 363LF0000X
AZAP0237367A00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0143460OtherBCBS
AZ472556Medicaid
AZAZ0143460OtherBCBS
AZ8HZK03Medicare ID - Type UnspecifiedPART B
AS030078Medicare Oscar/Certification
AZ472556Medicaid