Healthcare Provider Details

I. General information

NPI: 1477496032
Provider Name (Legal Business Name): ADVANTAGE PRIMARY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6546 E 2ND ST STE C
PRESCOTT VALLEY AZ
86314-3540
US

IV. Provider business mailing address

6546 E 2ND ST STE C
PRESCOTT VALLEY AZ
86314-3540
US

V. Phone/Fax

Practice location:
  • Phone: 928-327-7528
  • Fax: 928-327-7482
Mailing address:
  • Phone: 928-327-7528
  • Fax: 928-327-7482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DESIREE PENE
Title or Position: MANAGER
Credential:
Phone: 928-800-2295