Provider Demographics
NPI:1326175704
Name:ALTEN, KIMBERLY BAKER (APRN, BC, MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BAKER
Last Name:ALTEN
Suffix:
Gender:F
Credentials:APRN, BC, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 W HUGHES DR
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-3455
Mailing Address - Country:US
Mailing Address - Phone:626-374-7672
Mailing Address - Fax:928-468-9280
Practice Address - Street 1:287 E HUNT HWY STE 105
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5096
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:480-535-0962
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP-990047363LF0000X
CA429630363LF0000X
AZAP5687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily