Healthcare Provider Details

I. General information

NPI: 1427765247
Provider Name (Legal Business Name): ALISA KURTH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21729 N 77TH AVE STE 1
PEORIA AZ
85382-2108
US

IV. Provider business mailing address

21729 N 77TH AVE STE 1
PEORIA AZ
85382-2108
US

V. Phone/Fax

Practice location:
  • Phone: 623-335-1156
  • Fax:
Mailing address:
  • Phone: 623-335-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number282835
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: