Healthcare Provider Details

I. General information

NPI: 1477457679
Provider Name (Legal Business Name): SKY ISLAND COMMUNITY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 N JOHN ADAMS ST
ORACLE AZ
85623-0549
US

IV. Provider business mailing address

PO BOX 5392
ORACLE AZ
85623-5392
US

V. Phone/Fax

Practice location:
  • Phone: 520-440-4172
  • Fax:
Mailing address:
  • Phone: 520-440-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: KATHRYN LYNN CLARKE
Title or Position: FOUNDER
Credential: NP
Phone: 520-440-4172