1538708003 NPI number — KIMBERLY ANN TELFER FNP

Table of content: KIMBERLY ANN TELFER FNP (NPI 1538708003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538708003 NPI number — KIMBERLY ANN TELFER FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TELFER
Provider First Name:
KIMBERLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TITAK
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538708003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30388
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85275-0388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-830-3902
Provider Business Mailing Address Fax Number:
480-830-3901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4555 E INVERNESS AVE
Provider Second Line Business Practice Location Address:
STE 112
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-4630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-361-0110
Provider Business Practice Location Address Fax Number:
480-830-3901
Provider Enumeration Date:
01/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  209020467 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 263215 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 109074 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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