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General NPI Number Information
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NPI Number | 1750974960
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Entity Type | Organization
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Legal Business Name | VERDE VALLEY CONCIERGE MEDICINE PLLC
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Dates
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Enumeration Date | 02/18/2021
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 203 S CANDY LN STE 1A
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City | COTTONWOOD
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State | AZ
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Zip | 86326-8104
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Country | US
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Telephone | 928-852-4540
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Fax | 877-832-2119
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Provider Business Mailing Address
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Address Line | 203 S CANDY LN STE 1A
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City | COTTONWOOD
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State | AZ
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Zip | 86326-8104
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Country | US
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Telephone | 928-852-4540
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Fax | 877-832-2119
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Authorized Official
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Title or Position | MEMBER/PROVIDER
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Name | JASON KEABLE
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Credential | AGACNP-BC
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Telephone | 928-852-4540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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