Healthcare Provider Details

I. General information

NPI: 1972468080
Provider Name (Legal Business Name): JENNY KIEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13065 W MCDOWELL RD STE A105
AVONDALE AZ
85392-6440
US

IV. Provider business mailing address

9221 E BASELINE RD
MESA AZ
85209-8310
US

V. Phone/Fax

Practice location:
  • Phone: 623-536-6788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number261092
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: