NPIMap

Individual provider Active NPI

Mitzi D Nalley, PA-C

  • Physician Assistant
  • San Tan Valley, AZ
National Provider Identifier
1598722324
Registry record updated Jun 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2945 Issued in AZ
Practice address
668 E Penny LN
San Tan Valley, AZ 85140-4152
Phone
(480) 677-3842
NPI assigned
Apr 26, 2006
Last updated
Jun 17, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2945 AZ Primary

Addresses

Primary practice location

668 E Penny LN
San Tan Valley, AZ 85140-4152

Mailing address

668 E Penny LN
San Tan Valley, AZ 85140-4152
Phone (480) 677-3842

Other identifiers 1

IdentifierTypeStateIssuer
908238MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2945AZMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Nextcare Arizona I JV LLC Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients
Ucxtra Umbrella, LLC Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308268800000",
    "number": "1598722324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "668 E PENNY LN",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851404152",
            "telephone_number": "480-677-3842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "668 E PENNY LN",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851404152",
            "telephone_number": "480-677-3842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NALLEY",
        "first_name": "MITZI",
        "middle_name": "D",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-26",
        "last_updated": "2011-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "2945",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "908238",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Tan Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2011; 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.