Healthcare Provider Details

I. General information

NPI: 1154110146
Provider Name (Legal Business Name): KAYLEE POWERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 E BASELINE RD STE 129
MESA AZ
85206-4679
US

IV. Provider business mailing address

PO BOX 748817
ATLANTA GA
30374-8817
US

V. Phone/Fax

Practice location:
  • Phone: 480-644-1001
  • Fax: 480-464-8722
Mailing address:
  • Phone: 813-286-0033
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number272245
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: