Healthcare Provider Details

I. General information

NPI: 1437533288
Provider Name (Legal Business Name): KELLY MEIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY THOMPSON

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 AINSWORTH DR STE 103
PRESCOTT AZ
86301-1625
US

IV. Provider business mailing address

6000 N REATA DR
PRESCOTT VALLEY AZ
86314-3265
US

V. Phone/Fax

Practice location:
  • Phone: 480-927-3800
  • Fax: 480-400-6121
Mailing address:
  • Phone: 512-663-8803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP128485
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number262812
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: