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NPI Code Detail

MEDICARE: KELLY CHAVEZ NP

MEDICARE: KELLY CHAVEZ 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
1207Q00000XFamily Medicine Physician243687AZ

General Provider Information

NPI Number : 1588281687
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY CHAVEZ NP
Provider Business Mailing Address
First Line : 1625 N 39TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85009-2149
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1625 N 39TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85009-2149
Country : US
Telephone Number : 602-233-0017
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2020
Last Update Date : 10/22/2020

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Directions to “ KELLY CHAVEZ NP” Practice Location

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