DR. LUANNE TAKACS KELLY (NPI# 1073849360) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1073849360 |
Entity Type | Individual |
Full Name | DR. LUANNE TAKACS KELLY |
Credential | NP |
Practice Address |
2400 W Dunlap Ave Ste 125 Phoenix AZ 85021-2885 |
Mailing Address |
14609 N 60th Ave Glendale AZ 85306-3805 |
Practice Telephone | 5203408686 |
Practice Fax Number | 6237380425 |
Mailing Telephone | 5203408686 |
Mailing Fax Number | 6237384025 |
Enumeration Date | 2009-10-22 |
Last Update Date | 2020-07-08 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
AP3594 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
AZ | 1073849360 | 05 | |
AZ | 618876 | 05 | |
PA | NP LICENSE | UP80001B | 01 |
AZ | ANCC | 048119 | 01 |
AZ | ARIZONA BOARD OF NURSING | AP3594 | 01 |
AZ | MEDICARE | Z25025 | 01 |
Address | Telephone Number | Fax Number |
---|---|---|
20860 N Tatum Blvd Ste 300, Phoenix, AZ 850504283 | 5203408686 | 5203408686 |
Street Address |
2400 W DUNLAP AVE STE 125 |
City | PHOENIX |
State | AZ |
Zip Code | 85021-2885 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1205476868 | Bowser's Garden LLC | Nurse Practitioner | 2400 W Dunlap Ave Ste 125, Phoenix, AZ 85021-2885 | 2020-01-13 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1679173181 | Jill M Robinson | Social Worker | 8804 N. 23rd Ave, Bldg. A Ste. A01-a02, Phoenix, AZ 85021 | 2020-10-26 |
1528671013 | Sabrina Mcninch | Behavior Technician | 1200 W Dunlap Ave, Ste 100, Phoenix, AZ 85021 | 2020-08-25 |
1376169938 | Maricopa County Special Heallth Care District | Pharmacy | 2025 W Northern Ave, Phoenix, AZ 85021 | 2020-06-19 |
1841832664 | Madison Westby | Physical Therapist | 717 W Dunlap Ave # 100, Phoenix, AZ 85021 | 2019-10-14 |
1861967481 | Southwest Family Naturopathic Clinic Pllc | Naturopath | 1530 W Glendale Ave Suite 103, Phoenix, AZ 85021 | 2018-10-10 |
1184101461 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 8804 N 23rd Ave, Suite A01/a02, Phoenix, AZ 85021 | 2018-07-19 |
1568970150 | Alycia Ann Poloni | Occupational Therapist | 7129 N 23d Ave, Phoenix, AZ 85021 | 2018-01-17 |
1154839165 | Cyrus Professional Corporation | Dentist | 2401 W. Glendale Ave, Ste 102, Phoenix, AZ 85021 | 2018-01-12 |
1568980779 | Marla Jean Clay | Licensed Practical Nurse | 1717 W. Glendale Ave. Apt. 3011, Phoenix, AZ 85021 | 2017-09-07 |
1801325162 | Kaitlin King | Nurse Practitioner | 8824 N 9th Ave, Phoenix, AZ 85021 | 2017-06-08 |
Find all providers in zip 85021 |
Taxonomy Code | 363LA2200X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Adult Health |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1942819230 | Care On Pllc | Nurse Practitioner | 7171 S 51 Ave, Phoenix, AZ 85339-2923 | 2020-07-23 |
1558985036 | Amanda Stanford | Nurse Practitioner | 925 E Mc Dowell Rd, Phoenix, AZ 85006 | 2020-06-01 |
1710522024 | Kelsey Conrad | Nurse Practitioner | 1 E Lexington Ave Unit 1602, Phoenix, AZ 85012-4203 | 2019-11-11 |
1124662408 | Rayiom Health and Wellness, Inc | Nurse Practitioner | 11225 N 28th Dr Ste A102-22, Phoenix, AZ 85029-5606 | 2019-10-30 |
1699259580 | Keith Dibenedetto | Nurse Practitioner | 2617 Stockton Rd, Phoenix, MD 21131-1117 | 2018-09-18 |
1467975698 | Samantha June Collett | Nurse Practitioner | 3201 W Peoria Ave Ste 804, Phoenix, AZ 85029 | 2017-07-19 |
1598135741 | Sandra Shearer | Nurse Practitioner | 513 W Lavitt Ln, Phoenix, AZ 85086-6346 | 2015-09-30 |
1023499860 | Kelly Lynn Schultz | Nurse Practitioner | 3944 E Hillery Dr, Phoenix, AZ 85032-5245 | 2015-06-17 |
1609298900 | Lorna Ann Hill | Nurse Practitioner | 13224 N 31st Pl, Phoenix, AZ 85032-6041 | 2014-01-06 |
1801217765 | Trifit Pain Management LLC | Nurse Practitioner | 505 E Camelback Rd, Phoenix, AZ 85012-1615 | 2013-12-19 |
Find all providers in PHOENIX |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.