Provider Demographics
NPI:1659611390
Name:ISAAC, KIMBERLY J (NP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:ISAAC
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-4100
Mailing Address - Fax:520-324-1406
Practice Address - Street 1:10350 E DREXEL RD UNIT 110
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9409
Practice Address - Country:US
Practice Address - Phone:520-324-1727
Practice Address - Fax:520-324-1700
Is Sole Proprietor?:No
Enumeration Date:2013-02-17
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ829457Medicaid
AZAP4824OtherLICENSE
AZ829457Medicaid