Provider Demographics
NPI:1770751497
Name:ACKERMAN, KIMBERLY ANNE MURPHY (ACNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE MURPHY
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5228 OUTRIGGER WAY
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1823
Mailing Address - Country:US
Mailing Address - Phone:661-478-0844
Mailing Address - Fax:
Practice Address - Street 1:5228 OUTRIGGER WAY
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-1823
Practice Address - Country:US
Practice Address - Phone:661-478-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA613081163WR0006X
CA17532363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A104660OtherBLUE SHIELD PROVIDER NUMBER
CA20A104660OtherBLUE SHIELD PROVIDER NUMBER