| NPI | 1700566577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAILYNN CLARK Provider 480-518-5251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-07-18 |
| Last Update Date | 2024-05-11 |