MEDICARE: KELLY ANN TWILLING 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	RNP256015	AZ

General Provider Information

NPI Number	:	1790363182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANN TWILLING FNP-C

Provider Business Mailing Address
First Line	:	6411 S RIVER DR UNIT 33
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-3334
Country	:	US
Telephone Number	:	480-206-9443
Fax Number	:

Provider Business Practice Location Address
First Line	:	10290 N 92ND ST STE 100
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4508
Country	:	US
Telephone Number	:	480-425-4150
Fax Number	:	480-657-3491

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

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	03/29/2021

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Directions to “ KELLY ANN TWILLING FNP-C” Practice Location

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