Healthcare Provider Details

I. General information

NPI: 1033681283
Provider Name (Legal Business Name): KELLI CHASE GILL DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E MCDOWELL RD STE 101
PHOENIX AZ
85006-2607
US

IV. Provider business mailing address

1010 E MCDOWELL RD STE 101
PHOENIX AZ
85006-2607
US

V. Phone/Fax

Practice location:
  • Phone: 602-900-9404
  • Fax:
Mailing address:
  • Phone: 602-900-9404
  • Fax: 833-535-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number320825
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: