Healthcare Provider Details

I. General information

NPI: 1245268788
Provider Name (Legal Business Name): JULIE D WAITE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N STOCKTON HILL RD STE 108
KINGMAN AZ
86401-4140
US

IV. Provider business mailing address

13000 N 103RD AVE STE 59
SUN CITY AZ
85351-3056
US

V. Phone/Fax

Practice location:
  • Phone: 928-255-5050
  • Fax:
Mailing address:
  • Phone: 623-594-4126
  • Fax: 623-594-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number289530
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: