Healthcare Provider Details

I. General information

NPI: 1912613449
Provider Name (Legal Business Name): MY NP HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W UNION HILLS DR STE 350-4018
PHOENIX AZ
85027-5163
US

IV. Provider business mailing address

2550 W UNION HILLS DR STE 350-4018
PHOENIX AZ
85027-5163
US

V. Phone/Fax

Practice location:
  • Phone: 844-793-1923
  • Fax: 602-584-6216
Mailing address:
  • Phone: 844-793-1923
  • Fax: 602-584-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: GWENDOLYN MATHIS
Title or Position: DNP-PMHNP-FNP
Credential: NP
Phone: 844-793-1923