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General NPI Number Information
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NPI Number | 1508565284
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Entity Type | Organization
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Legal Business Name | BLUE SKY PSYCHIATRY LLC
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Dates
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Enumeration Date | 03/01/2023
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 2432 W PEORIA AVE STE 13421343
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City | PHOENIX
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State | AZ
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Zip | 85029-4726
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Country | US
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Telephone | 817-658-2216
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Fax |
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Provider Business Mailing Address
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Address Line | 10553 W APPALOOSA TRL
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City | CASA GRANDE
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State | AZ
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Zip | 85194-7612
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Country | US
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Telephone | 817-658-2216
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH A NEMBU
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Credential | PMHNP
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Telephone | 817-658-2216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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