Healthcare Provider Details

I. General information

NPI: 1043895030
Provider Name (Legal Business Name): KELLY LYNN LUNA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10217 N METRO PKWY W
PHOENIX AZ
85051-1438
US

IV. Provider business mailing address

6751 N SUNSET BLVD STE 320
GLENDALE AZ
85305-3155
US

V. Phone/Fax

Practice location:
  • Phone: 602-997-9006
  • Fax: 623-546-3140
Mailing address:
  • Phone: 623-343-2970
  • Fax: 623-546-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number255426
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: