Healthcare Provider Details

I. General information

NPI: 1952556599
Provider Name (Legal Business Name): KIM ERICA GARAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 S DOBSON RD SUITE 402
MESA AZ
85202-4768
US

IV. Provider business mailing address

8164 E WINDWOOD LN
SCOTTSDALE AZ
85255-6447
US

V. Phone/Fax

Practice location:
  • Phone: 480-412-5550
  • Fax:
Mailing address:
  • Phone: 480-658-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberUP004586N
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP5144
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: