Healthcare Provider Details

I. General information

NPI: 1114762424
Provider Name (Legal Business Name): LISA KENYON RN, APRN-RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S LINDSAY RD STE 124
GILBERT AZ
85297-1508
US

IV. Provider business mailing address

1760 E PECOS RD STE 307
GILBERT AZ
85295-3203
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-2643
  • Fax:
Mailing address:
  • Phone: 480-256-2648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number238019
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number238019
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: