Provider Demographics
NPI:1578337226
Name:BROSSART, KIMBERLY GROGAN (MPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:GROGAN
Last Name:BROSSART
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 E ELIDA ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3220
Mailing Address - Country:US
Mailing Address - Phone:520-405-5597
Mailing Address - Fax:
Practice Address - Street 1:3233 E ELIDA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3220
Practice Address - Country:US
Practice Address - Phone:520-405-5597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker