Prescott Family Practice and Wellness, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP7670 Issued in AZ

Legal business name

PRESCOTT FAMILY PRACTICE AND WELLNESS, LLC

Practice address

1151 W Iron Springs Rd Ste F
Prescott, AZ 86305-1614

Phone

(928) 533-1136

NPI assigned

Aug 16, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Stephanie Diane Ten Eyck, NP

Title

Owner

Phone

(480) 729-4939

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504051200000",
    "number": "1265958755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 VISTA DEL CERRO ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011059",
            "telephone_number": "480-729-4939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 W IRON SPRINGS RD STE F",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863051614",
            "telephone_number": "928-533-1136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCOTT FAMILY PRACTICE AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-16",
        "last_updated": "2017-08-30",
        "status": "A",
        "authorized_official_last_name": "TEN EYCK",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-729-4939",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP7670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.