Healthcare Provider Details

I. General information

NPI: 1912428343
Provider Name (Legal Business Name): JACKIE KAY LAVE' MSN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4435 E CHANDLER BLVD STE 200
PHOENIX AZ
85048-7651
US

IV. Provider business mailing address

3254 GRANGER AVE E APT B1
BILLINGS MT
59102-7060
US

V. Phone/Fax

Practice location:
  • Phone: 917-634-5311
  • Fax:
Mailing address:
  • Phone: 406-208-8617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number72727
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-127957
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNUR-APRN-LIC-127957
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: