Healthcare Provider Details

I. General information

NPI: 1184512949
Provider Name (Legal Business Name): KRISTINE MARIE CRANFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 E BANNER GATEWAY DR
GILBERT AZ
85234-2165
US

IV. Provider business mailing address

400 E EARLL DR UNIT 522
PHOENIX AZ
85012-0030
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-6444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11430
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: