Provider Demographics
NPI:1942939749
Name:SMITH, KIMBERLY CARMELLA (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CARMELLA
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6337 E CALLE HORA CERO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-0014
Mailing Address - Country:US
Mailing Address - Phone:201-388-6358
Mailing Address - Fax:
Practice Address - Street 1:6337 E CALLE HORA CERO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85756-0014
Practice Address - Country:US
Practice Address - Phone:201-388-6358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF05220760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily