Healthcare Provider Details

I. General information

NPI: 1932575883
Provider Name (Legal Business Name): JODIE MOKIHANA KAALEKAHI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 E THOMAS RD
PHOENIX AZ
85016
US

IV. Provider business mailing address

2929 E THOMAS RD
PHOENIX AZ
85016-8034
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-5020
  • Fax:
Mailing address:
  • Phone: 602-344-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0815105
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10265
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: