=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043554827
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE LITTLE CLINIC OF ARIZONA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2012
-----------------------------------------------------
Last Update Date | 10/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6470 S HIGLEY RD
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-809-2409
-----------------------------------------------------
Fax | 480-809-2410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2620 ELM HILL PIKE
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37214-3108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-425-4200
-----------------------------------------------------
Fax | 615-425-4271
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP & GENERAL MANAGER
-----------------------------------------------------
Name | MR. THOMAS SHELLY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-425-4200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------