Provider Demographics
NPI:1811356405
Name:MOSS, KIMBERLY C (FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:C
Last Name:MOSS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:C
Other - Last Name:ROLLINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-465-7211
Mailing Address - Fax:
Practice Address - Street 1:16260 S RANCHO SAHUARITA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-0740
Practice Address - Country:US
Practice Address - Phone:520-575-1175
Practice Address - Fax:520-757-1183
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017954363LF0000X
TN20910363LF0000X
AZ256716363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily