Healthcare Provider Details

I. General information

NPI: 1669398558
Provider Name (Legal Business Name): KAYLA MARIE STACKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13460 N 94TH DR STE J1
PEORIA AZ
85381-4264
US

IV. Provider business mailing address

13460 N 94TH DR STE J1
PEORIA AZ
85381-4264
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-8816
  • Fax: 623-298-0168
Mailing address:
  • Phone: 623-876-8816
  • Fax: 623-298-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN216532
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342025
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: