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General NPI Number Information
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NPI Number | 1912428343
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Entity Type | Individual
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Provider Name | JACKIE KAY LAVE' MSN, APRN
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Gender | Female
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 4435 E CHANDLER BLVD STE 200
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City | PHOENIX
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State | AZ
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Zip | 85048-7651
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Country | US
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Telephone | 917-634-5311
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Fax |
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Provider Business Mailing Address
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Address Line | 3254 GRANGER AVE E APT B1
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City | BILLINGS
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State | MT
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Zip | 59102-7060
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Country | US
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Telephone | 406-208-8617
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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 | 72727
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NUR-APRN-LIC-127957
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NUR-APRN-LIC-127957
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License Number State | MT
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