Healthcare Provider Details

I. General information

NPI: 1558215277
Provider Name (Legal Business Name): TIMOTHY HEADLEY PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13925 W MEEKER BLVD
SUN CITY WEST AZ
85375-4430
US

IV. Provider business mailing address

13925 W MEEKER BLVD
SUN CITY WEST AZ
85375-4430
US

V. Phone/Fax

Practice location:
  • Phone: 602-824-9309
  • Fax:
Mailing address:
  • Phone: 623-349-9864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number254877
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number254877
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: