MEDICARE: ALISA KURTH 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	282835	AZ

General Provider Information

NPI Number	:	1427765247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA KURTH FNP-C

Provider Business Mailing Address
First Line	:	21729 N 77TH AVE STE 1
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-2108
Country	:	US
Telephone Number	:	623-335-1156
Fax Number	:

Provider Business Practice Location Address
First Line	:	21729 N 77TH AVE STE 1
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-2108
Country	:	US
Telephone Number	:	623-335-1156
Fax Number	:

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

Provider Enumeration Date	:	11/01/2022
Last Update Date	:	04/22/2026

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