Healthcare Provider Details

I. General information

NPI: 1679356083
Provider Name (Legal Business Name): ALLISON PUTT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLISON KOEHLER

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 01/06/2024
Certification Date: 01/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16515 S 40TH ST STE 143
PHOENIX AZ
85048-0560
US

IV. Provider business mailing address

16515 S 40TH ST STE 143
PHOENIX AZ
85048-0560
US

V. Phone/Fax

Practice location:
  • Phone: 480-331-6322
  • Fax:
Mailing address:
  • Phone: 480-331-6322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number241569
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: