Healthcare Provider Details

I. General information

NPI: 1164352050
Provider Name (Legal Business Name): ASHLEY THOMPSON KELLOGG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6242 E ARBOR AVE STE 118
MESA AZ
85206-1309
US

IV. Provider business mailing address

6242 E ARBOR AVE STE 118
MESA AZ
85206-1309
US

V. Phone/Fax

Practice location:
  • Phone: 602-805-4914
  • Fax: 602-805-4917
Mailing address:
  • Phone: 602-805-4914
  • Fax: 602-805-4917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number264728
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number264728
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: