Individual provider Active NPI

Kimberly A. Hullett, NP

  • Acute Care Nurse Practitioner
  • Peoria, AZ
National Provider Identifier
1497794440
Registry record updated Feb 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP2483 Issued in AZ
Practice address
13460 N 94TH Dr Ste J1
Peoria, AZ 85381-4246
Phone
(623) 876-8816
Fax
(623) 298-0168
NPI assigned
Jun 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X AP2483 AZ
Acute Care Nurse Practitioner 363LA2100X AP2483 AZ Primary

Addresses

Primary practice location

13460 N 94TH Dr Ste J1
Peoria, AZ 85381-4246

Mailing address

13460 N 94TH Dr Ste J1
Peoria, AZ 85381-4246
Phone (623) 876-8816

Other identifiers 1

IdentifierTypeStateIssuer
153235MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061027000477 AZ Practitioner - Nurse Practitioner 8527065978 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
99.15 of 100Reported as group
Promoting interoperability
99
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5334WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Joseph a Caplan MD PC CurrentSince Nov 1, 2022 Accepting new patients
Pima Heart Physicians, PC Past Accepting new patients
Pima Heart Physicians, PC Past Accepting new patients
Pima Heart Physicians, PC Past Accepting new patients
Cardiac Care Consultants, PC Past Accepting new patients

Locations

5651 W Talavi Blvd
Ste 160
Glendale, AZ 85306

13460 N 94th Dr
Ste J1
Peoria, AZ 85381

9520 W Palm Ln
Ste 150
Phoenix, AZ 85037
Phone (602) 584-5444

14420 W Meeker Blvd
Bldg A305
Sun City West, AZ 85375

14420 W Meeker Blvd
Ste 305
Sun City West, AZ 85375
Phone (480) 772-9049

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1497794440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13460 N 94TH DR STE J1",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814246",
            "telephone_number": "623-876-8816",
            "fax_number": "623-298-0168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13460 N 94TH DR STE J1",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814246",
            "telephone_number": "623-876-8816",
            "fax_number": "623-298-0168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HULLETT",
        "first_name": "KIMBERLY",
        "middle_name": "A.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-05",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "AZ",
            "license": "AP2483",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "AP2483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "153235",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

Verify at the official NPI Registry.