Healthcare Provider Details

I. General information

NPI: 1154869261
Provider Name (Legal Business Name): MISTY A HULL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY HAINES FNP-C

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 S COTTON LN # F7-8
GOODYEAR AZ
85338-4637
US

IV. Provider business mailing address

261 N ROOSEVELT AVE
CHANDLER AZ
85226-2617
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-8282
  • Fax:
Mailing address:
  • Phone: 480-677-8282
  • Fax: 844-470-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11550
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: