Healthcare Provider Details

I. General information

NPI: 1942523667
Provider Name (Legal Business Name): KELLY MARIE SEZATE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 E BASELINE RD SUITE 203
GILBERT AZ
85234-2738
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 480-968-7600
  • Fax: 480-968-8003
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN133667
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: