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General NPI Number Information
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NPI Number | 1942776646
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Entity Type | Organization
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Legal Business Name | KELLY SCHULTZ, LLC.
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Dates
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Enumeration Date | 10/19/2018
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 4555 E MAYO BLVD
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City | PHOENIX
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State | AZ
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Zip | 85050-6952
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Country | US
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Telephone | 602-883-3647
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Fax |
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Provider Business Mailing Address
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Address Line | 4022 E GREENWAY ROAD SUITE 11-180
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City | PHOENIX
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State | AZ
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Zip | 85032-5245
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Country | US
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Telephone | 866-263-3820
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Fax | 866-857-9967
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Authorized Official
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Title or Position | OWNER
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Name | DR. KELLY L SCHULTZ
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Credential | DNP, RN, AGNP-C
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Telephone | 480-883-3647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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