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NPI Code Detail

MEDICARE: SUZANNE KELLEY NP

MEDICARE: SUZANNE KELLEY NP
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
1363L00000XNurse PractitionerRN063733AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RN063733OTHERAZNURSING LICENSE

General Provider Information

NPI Number : 1336118678
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUZANNE KELLEY NP
Provider Business Mailing Address
First Line : 222 W THOMAS RD STE 114
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-4420
Country : US
Telephone Number : 602-406-6304
Fax Number : 602-406-6302
Provider Business Practice Location Address
First Line : 222 W THOMAS RD STE 114
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-4420
Country : US
Telephone Number : 602-406-6304
Fax Number : 602-406-6302
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2006
Last Update Date : 08/23/2023

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Directions to “ SUZANNE KELLEY NP” Practice Location

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