Healthcare Provider Details

I. General information

NPI: 1316458508
Provider Name (Legal Business Name): KRISTI FORD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 W SACK DR STE 201
GLENDALE AZ
85308-7106
US

IV. Provider business mailing address

PO BOX 6423
CHANDLER AZ
85246-6423
US

V. Phone/Fax

Practice location:
  • Phone: 602-337-8500
  • Fax: 602-337-8151
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10451
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: