Healthcare Provider Details

I. General information

NPI: 1639097686
Provider Name (Legal Business Name): KARISSA JEAN BOURNE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14010 N NORTHSIGHT BLVD
SCOTTSDALE AZ
85260-3601
US

IV. Provider business mailing address

14010 N NORTHSIGHT BLVD
SCOTTSDALE AZ
85260-3601
US

V. Phone/Fax

Practice location:
  • Phone: 480-443-0384
  • Fax: 480-443-0389
Mailing address:
  • Phone: 480-443-0384
  • Fax: 480-443-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345513
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: