=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548995723
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GILKEY FAMILY CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2022
-----------------------------------------------------
Last Update Date | 07/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 E CEDAR AVE STE C-1
-----------------------------------------------------
City | FLAGSTAFF
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86004-1637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-224-9138
-----------------------------------------------------
Fax | 928-272-0112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1515 E CEDAR AVE STE C-1
-----------------------------------------------------
City | FLAGSTAFF
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86004-1637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-224-9138
-----------------------------------------------------
Fax | 928-272-0112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MATTHEW GILKEY
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 928-224-9138
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------