Healthcare Provider Details

I. General information

NPI: 1609961036
Provider Name (Legal Business Name): GLYNDA KEVIN SCHMELZLA RN, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KEVIN SCHMELZLA RNFA

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 E CALLE CENTURI
TUCSON AZ
85710-5424
US

IV. Provider business mailing address

1901 MILLER RD
ROWLETT TX
75088-5604
US

V. Phone/Fax

Practice location:
  • Phone: 520-392-8474
  • Fax: 520-392-8474
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN041640
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: