Healthcare Provider Details

I. General information

NPI: 1013574185
Provider Name (Legal Business Name): KASEY ALYSE HUEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3686 S ROME ST
GILBERT AZ
85297-7341
US

IV. Provider business mailing address

PO BOX 6423
CHANDLER AZ
85246-6423
US

V. Phone/Fax

Practice location:
  • Phone: 480-890-7705
  • Fax: 480-398-8095
Mailing address:
  • Phone: 480-890-7705
  • Fax: 480-398-8095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223071
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: