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General NPI Number Information
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NPI Number | 1578439113
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Entity Type | Individual
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Provider Name | KRISTIN LEIGH CHURCH
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Gender | Female
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 4409 W GELDING DR
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City | GLENDALE
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State | AZ
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Zip | 85306-4526
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Country | US
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Telephone | 480-433-3862
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Fax |
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Provider Business Mailing Address
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Address Line | 4409 W GELDING DR
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City | GLENDALE
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State | AZ
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Zip | 85306-4526
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Country | US
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Telephone | 480-433-3862
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 258783
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F12250240
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License Number State | AZ
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