MEDICARE: ENCHANTED SKY FAMILY PSYCHIATRY, PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1982545794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCHANTED SKY FAMILY PSYCHIATRY, PLLC

Provider Business Mailing Address
First Line	:	44480 W HONEYCUTT RD STE 103
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-2909
Country	:	US
Telephone Number	:	520-980-9251
Fax Number	:	520-667-2397

Provider Business Practice Location Address
First Line	:	44480 W HONEYCUTT RD STE 103
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-2909
Country	:	US
Telephone Number	:	520-980-9251
Fax Number	:	520-667-2397

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JENNIFER L GREEN
Credential	:	NP
Telephone Number	:	480-510-4292

Provider Enumeration Date	:	04/03/2026
Last Update Date	:	04/03/2026

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