Healthcare Provider Details

I. General information

NPI: 1235800319
Provider Name (Legal Business Name): KARISSA EILEEN CAIN DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 N 24TH ST STE B102
PHOENIX AZ
85016-6231
US

IV. Provider business mailing address

4131 N 24TH ST STE B102
PHOENIX AZ
85016-6231
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-4545
  • Fax: 602-903-7091
Mailing address:
  • Phone: 480-882-4545
  • Fax: 602-903-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number270531
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN183023
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: