Healthcare Provider Details

I. General information

NPI: 1487577383
Provider Name (Legal Business Name): KENZIE ELLSWORTH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40773 N IRONWOOD DR
SAN TAN VALLEY AZ
85140-7002
US

IV. Provider business mailing address

525 W BROWN RD
MESA AZ
85201-3202
US

V. Phone/Fax

Practice location:
  • Phone: 480-684-5000
  • Fax:
Mailing address:
  • Phone: 480-684-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number235334
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: