Healthcare Provider Details

I. General information

NPI: 1942776646
Provider Name (Legal Business Name): KELLY SCHULTZ, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
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: 602-883-3647
  • Fax:
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 Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. KELLY L SCHULTZ
Title or Position: OWNER
Credential: DNP, RN, AGNP-C
Phone: 480-883-3647