Healthcare Provider Details

I. General information

NPI: 1477046902
Provider Name (Legal Business Name): KYLE BART DEWEY DNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2018
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15820 N 35TH AVE STE 14
PHOENIX AZ
85053-7608
US

IV. Provider business mailing address

1743 E MENLO ST
MESA AZ
85203-1334
US

V. Phone/Fax

Practice location:
  • Phone: 866-207-3882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP11383
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: