Healthcare Provider Details

I. General information

NPI: 1164095808
Provider Name (Legal Business Name): KRISTEN NICHOLE READY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN NICHOLE MAJOR

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 02/05/2024
Certification Date: 04/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 N DYSART RD
GOODYEAR AZ
85395-2338
US

IV. Provider business mailing address

300 SW MT MAZAMA ST
MCMINNVILLE OR
97128-5571
US

V. Phone/Fax

Practice location:
  • Phone: 623-536-5309
  • Fax:
Mailing address:
  • Phone: 253-666-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number257852
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: