Healthcare Provider Details

I. General information

NPI: 1023499860
Provider Name (Legal Business Name): KELLY LYNN SCHULTZ DNP RN AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. KELLY LYNN SCHMIDT

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 E MAYO BLVD
PHOENIX AZ
85050-6952
US

IV. Provider business mailing address

4022 E GREENWAY ROAD SUITE 11-180
PHOENIX AZ
85032-5245
US

V. Phone/Fax

Practice location:
  • Phone: 480-384-5816
  • Fax: 480-384-5678
Mailing address:
  • Phone: 866-263-3820
  • Fax: 866-857-9967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberAP7895
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP7895
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP7895
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP7895
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: