Healthcare Provider Details

I. General information

NPI: 1013598689
Provider Name (Legal Business Name): KERI KATHERINE WHITNEY-LEE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

7615 N VIA DEL ELEMENTAL
SCOTTSDALE AZ
85258-3563
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone: 602-525-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number222213
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: