Vip IV & Medical Spa, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

VIP IV & MEDICAL SPA, LLC

Doing business as

VIP IV & Medical SPA, LLC

Practice address

1690 McCulloch Blvd N Ste 102
Lake Havasu City, AZ 86403-6560

Phone

(480) 404-4896

Fax

(480) 400-1063

NPI assigned

Aug 2, 2023

Last updated

Jan 11, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Kelley Robin Farley, FNP-CNPI 1861963845

Title

Owner, Family Nurse Practitioner

Phone

(480) 404-4896

Specialties & licenses 1

Addresses

Other names 1

• VIP IV & Medical SPA, LLC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelley Robin Farley, NP

  • Family Nurse Practitioner
  • Lake Havasu City, AZ
  • NPI 1861963845
  NPD Authorized official

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

{
    "created_epoch": "1690934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1447932280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1747 LOS LAGOS DR",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036625",
            "telephone_number": "480-404-4896",
            "fax_number": "480-400-1063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 MCCULLOCH BLVD N STE 102",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036560",
            "telephone_number": "480-404-4896",
            "fax_number": "480-400-1063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIP IV & MEDICAL SPA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-02",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "FARLEY",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_middle_name": "ROBIN",
        "authorized_official_title_or_position": "OWNER, FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "480-404-4896",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VIP IV & Medical SPA, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "VIP IV & Medical SPA, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Veritas Healthcare PLLC
• Tamara Vestal, RN153164
• Brooke Louise Vetter, O.D.
• Casandra Villafana, LMT
• Jade Marie Vinatieri, FNP-BC
• Nicholas Virden, P.T., DPT
• Vision Care Center
• Emily E Vona, FNP-C
• W Milyani MD PLLC (Frontier Skin and Cancer)
• Wal-Mart Store, Inc. (Vision Center 30-1364)

• Family Medicine Physician in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; 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.