Healthcare Provider Details

I. General information

NPI: 1063345924
Provider Name (Legal Business Name): ADITA FLAGG PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 S GOODYEAR BLVD E APT 188
GOODYEAR AZ
85338-4953
US

IV. Provider business mailing address

949 S GOODYEAR BLVD E APT 188
GOODYEAR AZ
85338-4953
US

V. Phone/Fax

Practice location:
  • Phone: 480-266-6567
  • Fax:
Mailing address:
  • Phone: 480-266-6567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number340189
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: