Healthcare Provider Details

I. General information

NPI: 1518689595
Provider Name (Legal Business Name): KARRIE BARGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9323 E BAHIA DR STE 100
SCOTTSDALE AZ
85260
US

IV. Provider business mailing address

9323 E BAHIA DR STE 100
SCOTTSDALE AZ
85260
US

V. Phone/Fax

Practice location:
  • Phone: 480-562-6610
  • Fax: 520-463-4419
Mailing address:
  • Phone: 480-562-6610
  • Fax: 520-463-4419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number279875
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN183570
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: