Healthcare Provider Details

I. General information

NPI: 1679025944
Provider Name (Legal Business Name): MICHELLE GILREATH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 W GUADALUPE RD STE 113
MESA AZ
85202-7250
US

IV. Provider business mailing address

2651 W GUADALUPE RD STE 113
MESA AZ
85202-7250
US

V. Phone/Fax

Practice location:
  • Phone: 480-253-9306
  • Fax: 833-973-4954
Mailing address:
  • Phone: 480-253-9306
  • Fax: 833-973-4954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number304886
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN182931
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: