Healthcare Provider Details

I. General information

NPI: 1245818640
Provider Name (Legal Business Name): ELIZABETH KEARNEY RN, NO-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 N SUNSET RD
APACHE JUNCTION AZ
85119-7864
US

IV. Provider business mailing address

847 N SUNSET RD
APACHE JUNCTION AZ
85119-7864
US

V. Phone/Fax

Practice location:
  • Phone: 480-528-2736
  • Fax:
Mailing address:
  • Phone: 480-528-2736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number251443
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: