Healthcare Provider Details

I. General information

NPI: 1255761235
Provider Name (Legal Business Name): ANDREA STULTS BSN, MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 E AGAVE RD
PHOENIX AZ
85044-0619
US

IV. Provider business mailing address

4425 E AGAVE RD
PHOENIX AZ
85044-0619
US

V. Phone/Fax

Practice location:
  • Phone: 623-777-7321
  • Fax: 747-203-0536
Mailing address:
  • Phone: 937-304-6829
  • Fax: 747-203-0536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5275
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP5275
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: