Healthcare Provider Details

I. General information

NPI: 1922110790
Provider Name (Legal Business Name): KAREN O KEKKONEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN O KEKKONEN FNP

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4233 W CAMINO VIVAZ
GLENDALE AZ
85310-5576
US

IV. Provider business mailing address

4233 W CAMINO VIVAZ
GLENDALE AZ
85310-5576
US

V. Phone/Fax

Practice location:
  • Phone: 602-826-0900
  • Fax: 602-936-0344
Mailing address:
  • Phone: 602-826-0900
  • Fax: 602-936-0344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN1201
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number102304
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP1201
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: