Lisette Amezcua, FNP
Individual provider Active NPI Family Nurse Practitioner · Avondale, AZ
NPI 1962266858 · NPPES record last updated Apr 22, 2025
Key facts
- NPI
- 1962266858
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 303781 (AZ)
- Practice address
- 10815 W McDowell Rd Ste 304
Avondale, AZ 85392-5016 - Phone
- (623) 433-0155
- NPI assigned
- Feb 12, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Privia Medical Group Arizona, LLC
Practice addresses (Care Compare)
10815 W McDowell Rd
Suite 304
Avondale, AZ 85392-5016
Phone (623) 433-0155
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- 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 |
|---|---|---|---|---|
| I20240423001190 | AZ | Practitioner - Nurse Practitioner | 7810336906 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Privia Medical Group Arizona, LLC | Current |
Accepting new patients | |
| Privia Medical Group Arizona, LLC | Current |
Accepting new patients | |
| Privia Medical Group Arizona, LLC | Past | Accepting new patients |
Locations
10815 W McDowell Rd
Ste 304
Avondale, AZ 85392
Phone (623) 433-0155
10815 W McDowell Rd
Ste 3
Avondale, AZ 85392
14415 W McDowell Rd
Ste D102
Goodyear, AZ 85395
Phone (623) 512-4190
111 W Cedar Ln
Ste A
Payson, AZ 85541
Phone (928) 472-4675
3815 E Bell Rd
Ste 4500
Phoenix, AZ 85032
Phone (602) 633-3838
Interoperability endpoints
- lisette.amezcua.2@33227.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 303781 | AZ | Yes |
Addresses
Primary practice location
10815 W McDowell Rd Ste 304
Avondale, AZ 85392-5016
Mailing address
3815 E Bell Rd Ste 4500
Phoenix, AZ 85032-2171
Phone (602) 633-3848
Other providers in Avondale, AZ
- Denise Alexa Amaya Arroyo
- Ryan David Ambrose
- Ambulatory Surgery Centers, LLC
- American Family Chiropractic & Rehab of Avondale LLC
- Amethyst Meadows Senior Care
- Amy Christine Amore
- Rajeswari Anaparthy
- Karen Anchondo Rodriguez
- Vanda Andelova
- Stacy Anderson Taouil
All providers in Avondale, AZ · Family 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 Apr 22, 2025. 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.