Healthcare Provider Details

I. General information

NPI: 1275460321
Provider Name (Legal Business Name): KINDLIGHT PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E AVENIDA SIERRA MADRE
GILBERT AZ
85296-1103
US

IV. Provider business mailing address

450 E AVENIDA SIERRA MADRE
GILBERT AZ
85296-1103
US

V. Phone/Fax

Practice location:
  • Phone: 907-227-2658
  • Fax:
Mailing address:
  • Phone: 907-227-2658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LISA RACANELLI
Title or Position: CEO
Credential: PMHNP-BC
Phone: 907-227-2658