Healthcare Provider Details

I. General information

NPI: 1033074273
Provider Name (Legal Business Name): JUPITER CANYON TELEHEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6219 W ALTADENA AVE
GLENDALE AZ
85304-3203
US

IV. Provider business mailing address

5830 W THUNDERBIRD RD STE B8
GLENDALE AZ
85306-4655
US

V. Phone/Fax

Practice location:
  • Phone: 623-745-1251
  • Fax: 808-673-0171
Mailing address:
  • Phone: 623-745-1251
  • Fax: 623-745-1251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY MCKENDALL
Title or Position: MANAGING MEMBER
Credential: NP
Phone: 623-745-1251