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NPI Code Detail

MEDICARE: KELLY JO PLENCNER-VEGA MSN,CNM

MEDICARE: KELLY JO PLENCNER-VEGA MSN,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
1367A00000XAdvanced Practice MidwifeAP8510AZ

General Provider Information

NPI Number : 1407302763
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY JO PLENCNER-VEGA MSN,CNM
Provider Business Mailing Address
First Line : PO BOX 95460
Second Line :
City : CLEVELAND
State : OH
Zip : 44101-0033
Country : US
Telephone Number : 602-581-6076
Fax Number : 602-263-1619
Provider Business Practice Location Address
First Line : 4212 N 16TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-5319
Country : US
Telephone Number : 602-263-1200
Fax Number : 602-263-1619
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2016
Last Update Date : 05/31/2026

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