Healthcare Provider Details

I. General information

NPI: 1356221089
Provider Name (Legal Business Name): KAITLYN KAY CUMMINGS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1743 E CAMELBACK RD STE A3
PHOENIX AZ
85016-4015
US

IV. Provider business mailing address

1743 E CAMELBACK RD STE A3
PHOENIX AZ
85016-4015
US

V. Phone/Fax

Practice location:
  • Phone: 602-325-5114
  • Fax: 602-325-5182
Mailing address:
  • Phone: 602-325-5114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number328458
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: