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General NPI Number Information
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NPI Number | 1871292789
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Entity Type | Individual
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Provider Name | KELLY JO MASTEN APRN-RNP
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Gender | Female
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 2175 W 16TH ST UNIT D
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City | SAFFORD
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State | AZ
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Zip | 85546-0842
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Country | US
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Telephone | 928-651-6372
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 367
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City | CENTRAL
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State | AZ
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Zip | 85531-0367
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Country | US
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Telephone | 928-651-6372
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 304698
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163WX0003X
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Taxonomy Name | Inpatient Obstetric Registered Nurse
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License Number | RN212349
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License Number State | AZ
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