Healthcare Provider Details

I. General information

NPI: 1770136004
Provider Name (Legal Business Name): MELLISA KERCHIEF NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6296 E GRANT RD STE 140
TUCSON AZ
85712-5876
US

IV. Provider business mailing address

2370 CORPORATE CIR STE 300
HENDERSON NV
89074-7760
US

V. Phone/Fax

Practice location:
  • Phone: 520-298-3321
  • Fax: 520-867-6721
Mailing address:
  • Phone: 702-910-3950
  • Fax: 702-786-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number226644
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: