Healthcare Provider Details

I. General information

NPI: 1386366979
Provider Name (Legal Business Name): AKUTEH JOY ACHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N GILBERT RD STE 206
GILBERT AZ
85234-2394
US

IV. Provider business mailing address

1501 N GILBERT RD STE 206
GILBERT AZ
85234-2394
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-7584
  • Fax:
Mailing address:
  • Phone: 480-626-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number260098
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number260098
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: