Healthcare Provider Details

I. General information

NPI: 1164667739
Provider Name (Legal Business Name): KELLY L ENGLAND FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 E CAMELBACK RD STE 600
PHOENIX AZ
85016-3493
US

IV. Provider business mailing address

2238 W CAMARGO DR
ANTHEM AZ
85086-1118
US

V. Phone/Fax

Practice location:
  • Phone: 212-396-6757
  • Fax:
Mailing address:
  • Phone: 805-396-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3539
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP3539
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN160953
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: