Healthcare Provider Details

I. General information

NPI: 1619413895
Provider Name (Legal Business Name): JAMIE KEARNEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E 15TH ST
DOUGLAS AZ
85607-1631
US

IV. Provider business mailing address

4220 N 161ST AVE
GOODYEAR AZ
85395
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-5437
  • Fax: 520-364-4261
Mailing address:
  • Phone: 520-270-5258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP7795
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: