Provider Demographics
NPI:1861112658
Name:CARTER, KIMBERLYN JOY (NP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLYN
Middle Name:JOY
Last Name:CARTER
Suffix:
Gender:
Credentials:NP
Other - Prefix:MS
Other - First Name:KIMBERLYN
Other - Middle Name:JOY
Other - Last Name:NAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 33269
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3269
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:485 S DOBSON RD STE 201
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5604
Practice Address - Country:US
Practice Address - Phone:480-728-4700
Practice Address - Fax:480-728-4747
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ280152363LA2200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health