Healthcare Provider Details

I. General information

NPI: 1043865561
Provider Name (Legal Business Name): KYLE ESTEP FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 N CENTRAL AVE STE 829
PHOENIX AZ
85004-1021
US

IV. Provider business mailing address

8342 E 7TH ST
TUCSON AZ
85710-2567
US

V. Phone/Fax

Practice location:
  • Phone: 866-949-0108
  • Fax: 901-422-7636
Mailing address:
  • Phone: 520-461-2097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number230334
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: