Healthcare Provider Details

I. General information

NPI: 1770374639
Provider Name (Legal Business Name): RAQUEL CHRISTINE KHOURY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 06/08/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

IV. Provider business mailing address

3030 E ESCUDA RD
PHOENIX AZ
85050-3503
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-5011
  • Fax:
Mailing address:
  • Phone: 480-241-6387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number233258
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: