Healthcare Provider Details

I. General information

NPI: 1124744396
Provider Name (Legal Business Name): ASHLEY MCKENDALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 05/24/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W BASELINE RD.
MESA AZ
85210
US

IV. Provider business mailing address

6219 W ALTADENA AVE
GLENDALE AZ
85304-3203
US

V. Phone/Fax

Practice location:
  • Phone: 480-559-3149
  • Fax:
Mailing address:
  • Phone: 808-673-0171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License NumberRN210369
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number291628
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: