Healthcare Provider Details

I. General information

NPI: 1760872550
Provider Name (Legal Business Name): KRYSTAL GAYLE CHERAPAN ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6328 E BROWN RD STE 106
MESA AZ
85205-4841
US

IV. Provider business mailing address

6328 E BROWN RD STE 106
MESA AZ
85205-4841
US

V. Phone/Fax

Practice location:
  • Phone: 480-654-3303
  • Fax: 480-654-4030
Mailing address:
  • Phone: 480-654-3303
  • Fax: 480-654-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP7582
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAP7582
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: