Healthcare Provider Details

I. General information

NPI: 1376169755
Provider Name (Legal Business Name): KINLEY WARD DNP, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 N WYATT DR STE 260
TUCSON AZ
85712-6118
US

IV. Provider business mailing address

2424 N WYATT DR STE 260
TUCSON AZ
85712-6118
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-8080
  • Fax:
Mailing address:
  • Phone: 520-795-0608
  • Fax: 520-795-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number242794
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: