Healthcare Provider Details

I. General information

NPI: 1891640017
Provider Name (Legal Business Name): MERADITH MCCORTNEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17839 N 15TH ST
PHOENIX AZ
85022-1295
US

IV. Provider business mailing address

17839 N 15TH ST
PHOENIX AZ
85022-1295
US

V. Phone/Fax

Practice location:
  • Phone: 928-713-1028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number254195
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: