Provider Demographics
NPI:1740302728
Name:FOUR PEAKS ELEMENTARY SCHOOL
Entity type:Organization
Organization Name:FOUR PEAKS ELEMENTARY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:PAM
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:480-982-1110
Mailing Address - Street 1:4126 N COLT RD
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85219-9643
Mailing Address - Country:US
Mailing Address - Phone:480-516-9332
Mailing Address - Fax:
Practice Address - Street 1:1755 N IDAHO RD
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85219-1716
Practice Address - Country:US
Practice Address - Phone:480-982-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty