MEDICARE: KAITLYN KAY CUMMINGS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	328458	AZ

General Provider Information

NPI Number	:	1356221089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN KAY CUMMINGS FNP

Provider Business Mailing Address
First Line	:	1743 E CAMELBACK RD STE A3
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4015
Country	:	US
Telephone Number	:	602-325-5114
Fax Number	:	602-325-5182

Provider Business Practice Location Address
First Line	:	1743 E CAMELBACK RD STE A3
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4015
Country	:	US
Telephone Number	:	602-325-5114
Fax Number	:	602-325-5182

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2025
Last Update Date	:	01/14/2026

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