Healthcare Provider Details

I. General information

NPI: 1073150496
Provider Name (Legal Business Name): KELLY RENEE MCALISTER CNP-F
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 N 7TH ST
PHOENIX AZ
85014-3653
US

IV. Provider business mailing address

PO BOX 748817
ATLANTA GA
30374-8817
US

V. Phone/Fax

Practice location:
  • Phone: 602-240-2401
  • Fax: 602-240-2401
Mailing address:
  • Phone: 813-286-0033
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number272151
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: