MEDICARE: KELLY A LAPA FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP10464	AZ

General Provider Information

NPI Number	:	1255856803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY A LAPA FNP-C

Provider Business Mailing Address
First Line	:	907 N MOUNTAIN RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-2309
Country	:	US
Telephone Number	:	480-789-2571
Fax Number	:	573-240-9791

Provider Business Practice Location Address
First Line	:	4700 S MCCLINTOCK DR STE 140
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7375
Country	:	US
Telephone Number	:	480-210-3407
Fax Number	:	573-240-9791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2017
Last Update Date	:	06/04/2025

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