Healthcare Provider Details

I. General information

NPI: 1104461508
Provider Name (Legal Business Name): MICHAEL KABYEMELA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2019
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E FLOWER ST BLDG 2
PHOENIX AZ
85014-5656
US

IV. Provider business mailing address

1510 E FLOWER ST BLDG 2
PHOENIX AZ
85014-5656
US

V. Phone/Fax

Practice location:
  • Phone: 480-268-2670
  • Fax: 877-268-2671
Mailing address:
  • Phone: 480-268-2670
  • Fax: 877-268-2671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number234156
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: