Healthcare Provider Details

I. General information

NPI: 1861112492
Provider Name (Legal Business Name): KALIYAH JAYNES DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 E VAN BUREN ST
PHOENIX AZ
85008-6920
US

IV. Provider business mailing address

3830 E VAN BUREN ST
PHOENIX AZ
85008-6920
US

V. Phone/Fax

Practice location:
  • Phone: 602-806-6655
  • Fax: 602-323-3496
Mailing address:
  • Phone: 602-243-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number218641
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: