Provider Demographics
NPI:1255690483
Name:DYER, KIMBERLY E (FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:E
Last Name:DYER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W ORANGE GROVE RD STE 416
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1141
Mailing Address - Country:US
Mailing Address - Phone:520-888-3032
Mailing Address - Fax:800-330-0592
Practice Address - Street 1:2001 W ORANGE GROVE RD STE 416
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1141
Practice Address - Country:US
Practice Address - Phone:520-888-3032
Practice Address - Fax:800-330-0592
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN127606163W00000X
AZAP4473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ867895Medicaid
AZ867895Medicaid