Provider Demographics
NPI:1750717757
Name:CHESTNUT, KIMBERLY MICHELE (CRNA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELE
Last Name:CHESTNUT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MICHELE
Other - Last Name:CHESTNUT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:4879 E GLENEAGLE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-7435
Mailing Address - Country:US
Mailing Address - Phone:480-580-9158
Mailing Address - Fax:
Practice Address - Street 1:5700 E HIGHWAY 90 FL 4
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-9110
Practice Address - Country:US
Practice Address - Phone:520-263-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN151774163W00000X
AZCRNA0987367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ163617Medicare PIN