Healthcare Provider Details

I. General information

NPI: 1730508227
Provider Name (Legal Business Name): KRISTEN RENEE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN RENEE MARTINEZ

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 S PRIEST DR STE 101
TEMPE AZ
85281-6204
US

IV. Provider business mailing address

1642 S PRIEST DR STE 101
TEMPE AZ
85281-6204
US

V. Phone/Fax

Practice location:
  • Phone: 480-929-5100
  • Fax:
Mailing address:
  • Phone: 480-929-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number346600
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: