Kelly Jo Masten, APRN-RNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

304698 Issued in AZ

Practice address

2175 W 16TH St Unit D
Safford, AZ 85546-0842

Phone

(928) 651-6372

NPI assigned

Feb 28, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AZ2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Mt Graham Regional Medical Center Inc

  • Critical Access Hospital
  • Safford, AZ
  • NPI 1275588345
  NPD (past)
• Mt Graham Regional Medical Center Inc

  • Rural Health Clinic/Center
  • Safford, AZ
  • NPI 1346528759
  NPD (past)

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

{
    "created_epoch": "1677542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1871292789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 367",
            "city": "CENTRAL",
            "state": "AZ",
            "postal_code": "855310367",
            "telephone_number": "928-651-6372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2175 W 16TH ST UNIT D",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855460842",
            "telephone_number": "928-651-6372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASTEN",
        "first_name": "KELLY JO",
        "name_prefix": "Mrs.",
        "credential": "APRN-RNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-28",
        "last_updated": "2024-03-05",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WX0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Obstetric, Inpatient",
            "state": "AZ",
            "license": "RN212349",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "304698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "304698",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RN212349",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandon Magill
• Main Street Family Medical, Inc.
• Christina Sue Marble, RN
• Chrisitne Ann Marciniak, OTRL
• Ali Marie Martinez, PTA
• Ronald L McAdam, DO
• David S McBride
• Carolyn Jo McCormies, FNP
• Raquel Mesa, RN
• Patrick Metz, LPC

• Family Nurse Practitioner in Safford, AZ
• Providers in Safford, 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 Mar 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.