Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
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Kimberly Samantha Rodriguez, PMHNP-BC

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1992659767

Kimberly Samantha Rodriguez, PMHNP-BC is a Nurse Practitioner in Provo, Utah. Qualified in 2025, 1 year ago. Works from 3 locations. Licensed in Utah.

Years since qualifying
1
Licensed in
UT
In the registry since
2026
What do these letters mean?
PMHNP-BC — Psychiatric-Mental Health Nurse Practitioner, Board Certified
A board-certified psychiatric nurse practitioner.

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Practice location Address checks out

395 W Cougar Blvd Ste 601
Provo, UT 84604-3331
Phone: (801) 357-7525
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 1433 N 1200 W, Orem, UT 84057-2449 — (801) 655-5450
  • 508 W 700 S, Payson, UT 84651-2735 — (801) 472-9850

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 11415541-8900 (UT)

Record details

NPI number1992659767
Entity typeIndividual (Type 1)
GenderFemale
Credentials PMHNP-BC
Sole proprietorNo
NPI enumeratedFebruary 26, 2026
Last updated in NPPESSeptember 2, 2026
Certification dateSeptember 2, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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