Provider Demographics
NPI:1689675522
Name:QUIRING, KIMBERLY ANNE (PA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:QUIRING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 W FAIRVIEW ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4712
Mailing Address - Country:US
Mailing Address - Phone:480-800-4890
Mailing Address - Fax:800-427-4766
Practice Address - Street 1:2201 W FAIRVIEW ST STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4712
Practice Address - Country:US
Practice Address - Phone:480-800-4890
Practice Address - Fax:800-427-4766
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7716363A00000X
TN1353363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6008008OtherBCBS TN
TN4155804OtherBLUE CROSS
VI1689675522Medicaid
TN1508224Medicaid
OH04972Medicare UPIN
TN6008008OtherBCBS TN
VI1689675522Medicaid
TN4155804OtherBLUE CROSS
TNQ04972Medicare UPIN