MEDICARE: TIMOTHY HEADLEY PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	254877	AZ
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	254877	AZ

General Provider Information

NPI Number	:	1558215277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY HEADLEY PMHNP-BC

Provider Business Mailing Address
First Line	:	2122 W TRACY LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-4369
Country	:	US
Telephone Number	:	623-349-9864
Fax Number	:

Provider Business Practice Location Address
First Line	:	2122 W TRACY LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-4369
Country	:	US
Telephone Number	:	623-349-9864
Fax Number	:

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

Provider Enumeration Date	:	02/21/2026
Last Update Date	:	03/05/2026

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