Healthcare Provider Details

I. General information

NPI: 1174633051
Provider Name (Legal Business Name): CHARITY MARIE CORREA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARITY M. KINCADE FNP-BC

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 W THOMAS RD
PHOENIX AZ
85033-5700
US

IV. Provider business mailing address

36590 N BOULDER VIEW DR
SCOTTSDALE AZ
85262-3909
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax: 623-247-9742
Mailing address:
  • Phone: 602-449-2811
  • Fax: 602-449-2812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberAP4512
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP4512
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: