MEDICARE: JEFFREY ELY PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	244594	AZ

General Provider Information

NPI Number	:	1710763131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY ELY PMHNP

Provider Business Mailing Address
First Line	:	4545 E CHANDLER BLVD STE 308
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-7646
Country	:	US
Telephone Number	:	480-626-7584
Fax Number	:

Provider Business Practice Location Address
First Line	:	4545 E CHANDLER BLVD STE 308
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-7646
Country	:	US
Telephone Number	:	480-956-5660
Fax Number	:

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

Provider Enumeration Date	:	09/01/2023
Last Update Date	:	05/29/2026

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