MEDICARE: MRS. JETTA VALLE MSN, PMHNP, FNP

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	207QA0401X	Addiction Medicine (Family Medicine) Physician	AP10652	AZ
2	363LF0000X	Family Nurse Practitioner	AP10652	AZ
3	363LP2300X	Primary Care Nurse Practitioner	AP10652	AZ
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP10652	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720336910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JETTA VALLE MSN, PMHNP, FNP

Provider Business Mailing Address
First Line	:	21168 E OCOTILLO RD # 1271
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-8175
Country	:	US
Telephone Number	:	520-677-8025
Fax Number	:	888-205-9338

Provider Business Practice Location Address
First Line	:	21168 E OCOTILLO RD # 1271
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-8175
Country	:	US
Telephone Number	:	520-677-8025
Fax Number	:	888-205-9338

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

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	08/24/2025

Similar Medicare Providers

1225624729 — SHAVAUN JOHNSON NP
Practice Location Address:

21168 E OCOTILLO RD # 1045
QUEEN CREEK, AZ
85142-8175

Practice Phone: 623-265-6220
Practice Fax: 866-491-7389

1114690401 — LIGHT AT THE END PLLC
Practice Location Address:

21168 E OCOTILLO RD # 1045
QUEEN CREEK, AZ
85142-8175

Practice Phone: 623-265-6220
Practice Fax: 866-491-7389

1649714486 — ALLISON MARIE BROWN
Practice Location Address:

817 STONE CREEK CIR
GENOA, IL
60135-8175

Practice Phone: 815-751-5657
Practice Fax:

1275390205 — EMPOWER HER THERAPY
Practice Location Address:

W4795 DEER RUN DR
BLACK CREEK, WI
54106-8175

Practice Phone: 920-205-6158
Practice Fax:

1720810682 — GRACE HEALTH, INC.
Practice Location Address:

8175 C DR N RM 10
BATTLE CREEK, MI
49014-7548

Practice Phone: 269-441-3250
Practice Fax:

1770440547 — ANNIKA SANDSTEDT DPT
Practice Location Address:

20851 E RITTENHOUSE RD
QUEEN CREEK, AZ
85142-4493

Practice Phone: 480-677-3294
Practice Fax:

Directions to “ MRS. JETTA VALLE MSN, PMHNP, FNP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.