Provider Demographics
NPI:1538708003
Name:TELFER, KIMBERLY ANN (FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:TELFER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:TITAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 30388
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85275-0388
Mailing Address - Country:US
Mailing Address - Phone:480-830-3902
Mailing Address - Fax:480-830-3901
Practice Address - Street 1:4555 E INVERNESS AVE
Practice Address - Street 2:STE 112
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4630
Practice Address - Country:US
Practice Address - Phone:480-361-0110
Practice Address - Fax:480-830-3901
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020467363L00000X
AZ263215363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ109074Medicaid