Provider Demographics
NPI:1811543978
Name:VICE, KIMBERLY R (WHNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:VICE
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:R
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:530 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3204
Mailing Address - Country:US
Mailing Address - Phone:602-422-9000
Mailing Address - Fax:602-556-5951
Practice Address - Street 1:3815 S. VAL VISTA DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7309
Practice Address - Country:US
Practice Address - Phone:480-782-0993
Practice Address - Fax:855-329-8939
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ230226363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health