Healthcare Provider Details

I. General information

NPI: 1386821593
Provider Name (Legal Business Name): LEE ANN KELLEY, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 N 40TH ST SUITE 101
PHOENIX AZ
85032-3345
US

IV. Provider business mailing address

16601 N 40TH ST SUITE 101
PHOENIX AZ
85032-3345
US

V. Phone/Fax

Practice location:
  • Phone: 602-795-1834
  • Fax: 602-795-2608
Mailing address:
  • Phone: 602-795-1834
  • Fax: 602-795-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25986
License Number StateAZ

VIII. Authorized Official

Name: DR. LEE ANN KELLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 602-795-1834