Kendallyn Ashley, FNP
Individual provider Active NPI Primary Care Nurse Practitioner · Phoenix, AZ
NPI 1336323005 · NPPES record last updated Jun 12, 2024
Key facts
- NPI
- 1336323005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- AP 9639 (AZ)
- Practice address
- 4212 N 16TH St
Phoenix, AZ 85016-5319 - Phone
- (602) 263-1200
- NPI assigned
- Dec 18, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dhew Ind HLTH SV HLTH SVS and MNTL HLTH Adm
Practice addresses (Care Compare)
4212 N 16TH St
Phoenix, AZ 85016-5319
Phone (602) 263-1200
Hospital & facility affiliations
- Phoenix Indian Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170509000016 | TX | Practitioner - Nurse Practitioner | 6709163363 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP 9639 | AZ | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm | Current |
Accepting new patients | |
| Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm | Current |
Accepting new patients |
Locations
4212 N 16th St
Phoenix, AZ 85016
Phone (602) 248-4187
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN141178 | AZ | |
| Primary Care Nurse Practitioner | 363LP2300X | AP 9639 | AZ | Yes |
Addresses
Primary practice location
4212 N 16TH St
Phoenix, AZ 85016-5319
Mailing address
PO Box 95460
Cleveland, OH 44101-0033
Phone (602) 263-1200
Other providers in Phoenix, AZ
- Anthony Michael Asher
- Barbara Asher
- Darina Asher
- Ashley Clyde LLC
- Ashley Robinson NP
- Michael Ashley
- Michael E Ashley
- Michelle Ashley
- Christopher Troy Ashment
- Zoha Ashraf
All providers in Phoenix, AZ · Primary Care Nurse Practitioner in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.