Healthcare Provider Details

I. General information

NPI: 1144152711
Provider Name (Legal Business Name): DUCRAY WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22838 E TWILIGHT DR
QUEEN CREEK AZ
85142-2184
US

IV. Provider business mailing address

22838 E TWILIGHT DR
QUEEN CREEK AZ
85142-2184
US

V. Phone/Fax

Practice location:
  • Phone: 480-202-4044
  • Fax: 480-522-3444
Mailing address:
  • Phone: 480-202-4044
  • Fax: 480-522-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KELLI DUCRAY
Title or Position: NURSE PRACTITIONER
Credential: ACNP-BC
Phone: 480-202-4044