MEDICARE: KELLEY HAZEL CNM

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	367A00000X	Advanced Practice Midwife

General Provider Information

NPI Number	:	1326561499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY HAZEL CNM

Provider Business Mailing Address
First Line	:	PO BOX 748860
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374
Country	:	US
Telephone Number	:	480-821-3600
Fax Number	:	480-821-3610

Provider Business Practice Location Address
First Line	:	3530 S VAL VISTA DR STE 203
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-7322
Country	:	US
Telephone Number	:	480-917-6480
Fax Number	:	480-857-2667

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

Provider Enumeration Date	:	07/20/2017
Last Update Date	:	06/26/2023

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