Healthcare Provider Details

I. General information

NPI: 1831831510
Provider Name (Legal Business Name): COURTNEY BRADFORD AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY KISTLER AGACNP-BC

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 N FIESTA BLVD STE 100
GILBERT AZ
85233-1032
US

IV. Provider business mailing address

6343 E MAIN ST STE 12
MESA AZ
85205-8955
US

V. Phone/Fax

Practice location:
  • Phone: 480-835-6100
  • Fax:
Mailing address:
  • Phone: 480-835-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number271346
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: