Healthcare Provider Details

I. General information

NPI: 1275872848
Provider Name (Legal Business Name): KELLY LYNNE ARMENTA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2013
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16515 S 40TH ST SUITE 139
PHOENIX AZ
85048-0558
US

IV. Provider business mailing address

16515 S 40TH ST SUITE 139
PHOENIX AZ
85048-0558
US

V. Phone/Fax

Practice location:
  • Phone: 480-706-0174
  • Fax:
Mailing address:
  • Phone: 480-706-0174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN137531
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4946
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: