Healthcare Provider Details

I. General information

NPI: 1306338736
Provider Name (Legal Business Name): KELLI KAY DUCRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S POWER RD STE 102
MESA AZ
85206-5297
US

IV. Provider business mailing address

140 S POWER RD STE 102
MESA AZ
85206-5297
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-4343
  • Fax:
Mailing address:
  • Phone: 480-945-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP11335
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP11335
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: