Healthcare Provider Details

I. General information

NPI: 1952376923
Provider Name (Legal Business Name): KRISTEN A. BRANCHE WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN A. MINNICK-SMITH NP

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 03/07/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 E CONFERENCE DR STE 115
TEMPE AZ
85284-2604
US

IV. Provider business mailing address

2155 E CONFERENCE DR STE 115
TEMPE AZ
85284-2604
US

V. Phone/Fax

Practice location:
  • Phone: 480-831-2445
  • Fax: 480-897-1283
Mailing address:
  • Phone: 480-831-2445
  • Fax: 480-897-1283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN254159L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP2657
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: