Pops Provisional Place LLC

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

044613 Issued in AZ

Legal business name

POPS PROVISIONAL PLACE LLC

Practice address

29741 W Amelia Ave
Buckeye, AZ 85396-7169

Phone

(623) 693-3112

Fax

(623) 434-3882

NPI assigned

Sep 14, 2017

Organization subpart

No

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

Authorized official

Name

Mrs. Marcia Dianne Crayton, LPN

Title

Administrator

Phone

(623) 693-3112

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1505347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1952820557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29741 W AMELIA AVE",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853967169",
            "telephone_number": "623-693-3112",
            "fax_number": "623-434-3882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29741 W AMELIA AVE",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853967169",
            "telephone_number": "623-693-3112",
            "fax_number": "623-434-3882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POPS PROVISIONAL PLACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-14",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "CRAYTON",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_middle_name": "DIANNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "623-693-3112",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "AZ",
            "license": "044613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Pierce III, SLPA
• Kristen Irene Pizzillo
• Melissa Plascencia
• Eufemio Contreras Polanco, PHYSICIAN ASSISTANT
• Daniel Ponce, DDS
• Shelly Potter, DPT
• Pawat Poupongtong, DPT
• Hailey Powell
• Alec Pramhus, MD
• Mariah Price

• Licensed Practical Nurse in Buckeye, AZ
• Providers in Buckeye, AZ by specialty
• Licensed Practical Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.