Healthcare Provider Details

I. General information

NPI: 1356753008
Provider Name (Legal Business Name): DONNA J. CALLICUTT DNP, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 E THOMPSON PEAK PKWY STE 100
SCOTTSDALE AZ
85255-7402
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 480-661-1679
  • Fax:
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAG0514029
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP5610
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: