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General NPI Number Information
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NPI Number | 1245067099
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Entity Type | Individual
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Provider Name | KYLEE MARTIN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/16/2024
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 5860 S HOSPITAL DR STE 102
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City | GLOBE
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State | AZ
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Zip | 85501-9449
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Country | US
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Telephone | 928-402-0491
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Fax |
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Provider Business Mailing Address
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Address Line | 1833 N 2500 W
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City | ST GEORGE
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State | UT
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Zip | 84770-4702
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Country | US
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Telephone | 435-272-7858
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1318428
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License Number State | AZ
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