Provider Demographics
NPI:1104157742
Name:HERMAN, KIMBERLY H (FNP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:H
Last Name:HERMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 E SHEA BLVD STE 200266
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3345
Mailing Address - Country:US
Mailing Address - Phone:480-977-6000
Mailing Address - Fax:248-269-0631
Practice Address - Street 1:3420 E SHEA BLVD STE 200266
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028
Practice Address - Country:US
Practice Address - Phone:480-977-6000
Practice Address - Fax:248-269-0631
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily