Healthcare Provider Details

I. General information

NPI: 1992663991
Provider Name (Legal Business Name): ELEV
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3222 W BAJADA DR
PHOENIX AZ
85083-5823
US

IV. Provider business mailing address

3222 W BAJADA DR
PHOENIX AZ
85083-5823
US

V. Phone/Fax

Practice location:
  • Phone: 623-205-6473
  • Fax:
Mailing address:
  • Phone: 623-205-6473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTIN NICHOLE MARTH
Title or Position: MANAGING MEMBER
Credential: FNP-C
Phone: 623-205-6473