Provider Demographics
NPI:1407164767
Name:WHITEHILL, KIMBERLY ANN (FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:WHITEHILL
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 1:17301 E SPRING VALLEY RD STE F
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86333-4263
Mailing Address - Country:US
Mailing Address - Phone:928-632-4909
Mailing Address - Fax:928-632-4973
Practice Address - Street 1:17301 E SPRING VALLEY RD STE F
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86333
Practice Address - Country:US
Practice Address - Phone:928-632-4909
Practice Address - Fax:928-632-4973
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19859363LF0000X
AZAP8027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN193646OtherARIZONA STATE BOARD OF NURSING
AZAP8027OtherARIZONA STATE BOARD OF NURSING
AZZ205470OtherMEDICARE