Provider Demographics
NPI:1184346793
Name:NOVAK, KIMBERLY R (FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:NOVAK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 S SUTTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-8054
Mailing Address - Country:US
Mailing Address - Phone:928-251-4244
Mailing Address - Fax:833-539-1739
Practice Address - Street 1:5300 S SUTTER DR STE A
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-8054
Practice Address - Country:US
Practice Address - Phone:928-251-4244
Practice Address - Fax:833-539-1739
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ280725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily