Individual
MISS KIMBERLY JEAN HANNERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1066 N POWER RD STE 101, MESA, AZ 85205-5709
(480) 807-0130
Mailing address
9661 E TAHOE CIR, MESA, AZ 85212-2192
(479) 276-0796
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11022
AZ
363A00000X
Physician Assistant
141908
MT
363A00000X
Physician Assistant
MA062451
PA
Other
Enumeration date
08/05/2019
Last updated
04/10/2025
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