Healthcare Provider Details

I. General information

NPI: 1093238651
Provider Name (Legal Business Name): KAYLEENA JEANINE- TEJADA CHENTFANT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6648 N VIEWPOINT DR STE 5
PRESCOTT VALLEY AZ
86315-4942
US

IV. Provider business mailing address

1065 W ROAD 2 S
CHINO VALLEY AZ
86323-8801
US

V. Phone/Fax

Practice location:
  • Phone: 928-708-4800
  • Fax: 928-458-2123
Mailing address:
  • Phone: 623-271-1764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10384
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: