Healthcare Provider Details

I. General information

NPI: 1194722256
Provider Name (Legal Business Name): JOHN KEVIN EKMAN FNP- C, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 W 8TH ST
SAFFORD AZ
85546-2807
US

IV. Provider business mailing address

510 23RD ST.
SAFFORD AZ
85546
US

V. Phone/Fax

Practice location:
  • Phone: 928-428-6554
  • Fax: 928-428-7266
Mailing address:
  • Phone: 928-348-9602
  • Fax: 928-428-7266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP1902
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP1902
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: