Healthcare Provider Details

I. General information

NPI: 1083810451
Provider Name (Legal Business Name): PHYLLIS PATRICIA SALKEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18270 SISKIYOU RD STE B
APPLE VALLEY CA
92307
US

IV. Provider business mailing address

18270 SISKIYOU RD STE B
APPLE VALLEY CA
92307-1413
US

V. Phone/Fax

Practice location:
  • Phone: 760-949-4118
  • Fax:
Mailing address:
  • Phone: 760-949-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number22894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: