Healthcare Provider Details

I. General information

NPI: 1326970625
Provider Name (Legal Business Name): STACEY LEE ARNETT BSN,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. STACEY LEE KELLEY

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5738 W MORTEN AVE
GLENDALE AZ
85301-1328
US

IV. Provider business mailing address

5738 W MORTEN AVE
GLENDALE AZ
85301-1328
US

V. Phone/Fax

Practice location:
  • Phone: 831-512-2695
  • Fax:
Mailing address:
  • Phone: 831-512-2695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number313678
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: