MEDICARE: JO KELSEY 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	261QU0200X	Urgent Care Clinic/Center	TAP5041	AZ

General Provider Information

NPI Number	:	1922440403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO KELSEY FNP

Provider Business Mailing Address
First Line	:	15791 W MAUI LN
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85379-6274
Country	:	US
Telephone Number	:	623-262-0639
Fax Number	:

Provider Business Practice Location Address
First Line	:	10249 W THUNDERBIRD BLVD STE 300
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3113
Country	:	US
Telephone Number	:	623-262-0639
Fax Number	:

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

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	07/24/2013

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