Alzetta Clay Obahiagbon

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

255362 Issued in AZ

Practice address

1750 E Broadway Rd
Tempe, AZ 85282-1612

Phone

(480) 557-0970

NPI assigned

Oct 31, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

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.

• Minuteclinic LLC

  • Family Nurse Practitioner
  • Rockville, MD
  • NPI 1134191836
  NPD

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

{
    "created_epoch": "1604102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1992305551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 E BROADWAY RD",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852821612",
            "telephone_number": "480-557-0970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 E BROADWAY RD",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852821612",
            "telephone_number": "480-557-0970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBAHIAGBON",
        "first_name": "ALZETTA",
        "middle_name": "CLAY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-31",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN195688",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "255362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• O&T Health and Wellness Center LLC
• Jafaru Jeff Oaikhena
• Oak Point Wellness Center
• Emily Sumiko Oandasan, M.A. EDUCATION, COUN
• Oasis Therapy Services, LLC
• Ammar A Obaidalla
• Karen Oberg
• Pamela Sue Obermeyer, LCSW
• Todd Vincent Obermeyer
• Caren J Oberstein, CAREN OBERSTEIN

• Family Nurse Practitioner in Tempe, AZ
• Providers in Tempe, 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 Jun 10, 2021; 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.