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NPI Code Detail

MEDICARE: KELLY DANIELLE EARLEY ACNP

MEDICARE: KELLY DANIELLE EARLEY ACNP
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
1363LA2100XAcute Care Nurse Practitioner815665NV
2363L00000XNurse PractitionerNP95021121CA
3363L00000XNurse Practitioner336565AZ

General Provider Information

NPI Number : 1972257699
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY DANIELLE EARLEY ACNP
Provider Business Mailing Address
First Line : 11234 ANDERSON ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92350-1716
Country : US
Telephone Number : 909-558-4483
Fax Number :
Provider Business Practice Location Address
First Line : 13400 E SHEA BLVD
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85259-5499
Country : US
Telephone Number : 480-301-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2022
Last Update Date : 04/06/2026

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