Healthcare Provider Details

I. General information

NPI: 1558649186
Provider Name (Legal Business Name): ELISSA M KEEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISSA M POCIUS AND VER HEY

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N BEAVER ST
FLAGSTAFF AZ
86001-3118
US

IV. Provider business mailing address

3200 E CAMELBACK RD STE 250
PHOENIX AZ
85018-2327
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-2112
  • Fax:
Mailing address:
  • Phone: 602-933-1814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP4486
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number153520
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberAP4486
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: