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General NPI Number Information
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NPI Number | 1720336910
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Entity Type | Individual
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Provider Name | JETTA VALLE MSN, PMHNP, FNP
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Gender | Female
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 08/24/2025
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Provider Practice Location Address
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Address Line | 21168 E OCOTILLO RD # 1271
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-8175
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Country | US
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Telephone | 520-677-8025
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Fax | 888-205-9338
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Provider Business Mailing Address
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Address Line | 21168 E OCOTILLO RD # 1271
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-8175
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Country | US
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Telephone | 520-677-8025
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Fax | 888-205-9338
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | AP10652
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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 | AP10652
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AP10652
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP10652
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License Number State | AZ
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