Kimberly Anne McClintic, F.N.P.-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP2746 Issued in AZ

Practice address

9900 Bren Rd E
Minnetonka, MN 55343-9664

Phone

(480) 865-4839

NPI assigned

Sep 12, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Ms. Kimberly Anne Petersen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Arizona State University

  • Audiologist
  • Tempe, AZ
  • NPI 1952338865
  NPD (past)
• Integrative Cardiology PLLC

  • Cardiovascular Disease Physician
  • Scottsdale, AZ
  • NPI 1649262064
  NPD (past)

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

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593388800000",
    "number": "1518152511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7814 E GRANADA RD",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852572247",
            "telephone_number": "480-865-4839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 BREN RD E",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553439664",
            "telephone_number": "480-865-4839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLINTIC",
        "first_name": "KIMBERLY",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "F.N.P.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-12",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP2746",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "AP2746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275028",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "PETERSEN",
            "middle_name": "ANNE",
            "prefix": "MS.",
            "credential": "F.N.P.-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Zachary McCalley
• Alexandra McCannel, MA, LMFT
• Timothy McCarren
• Linda McCarthy, APNP
• Sara Decker McCarthy, CCLS
• Jared Ronald McComber
• Amelia Levake McConachie, RD
• Brittney Teresa McCoy, MS, SLP
• Catherine L McDaniel, FNP-C
• Marin Ruth McDonough

• Nurse Practitioner in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.