Healthcare Provider Details

I. General information

NPI: 1548895105
Provider Name (Legal Business Name): JILL RICHEY CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 E VAN BUREN ST
PHOENIX AZ
85008-6920
US

IV. Provider business mailing address

3830 E VAN BUREN ST
PHOENIX AZ
85008-6920
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN192494
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number273526
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: