Provider Demographics
NPI:1376118919
Name:SPENCER, KIMBERLI MAE (DNP, APRN, FNP)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLI
Middle Name:MAE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:DNP, APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 N CENTRAL AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2639
Mailing Address - Country:US
Mailing Address - Phone:602-230-7373
Mailing Address - Fax:
Practice Address - Street 1:610 E BASELINE RD STE 5
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6536
Practice Address - Country:US
Practice Address - Phone:602-230-7373
Practice Address - Fax:602-441-5836
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ258025363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care