Provider Demographics
NPI:1366210619
Name:COWLEY, KIMBERLY MICHELLE (FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:COWLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12601 EDGEMONT LN APT 43
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2963
Mailing Address - Country:US
Mailing Address - Phone:714-322-1564
Mailing Address - Fax:
Practice Address - Street 1:16501 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:SUNSET BEACH
Practice Address - State:CA
Practice Address - Zip Code:90742-2091
Practice Address - Country:US
Practice Address - Phone:562-592-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily