Provider Demographics
NPI:1083367155
Name:HUEBSCH, KYLEE (DNP-FNP)
Entity Type:Individual
Prefix:DR
First Name:KYLEE
Middle Name:
Last Name:HUEBSCH
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10814 E ADOBE RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-3103
Mailing Address - Country:US
Mailing Address - Phone:480-589-1317
Mailing Address - Fax:
Practice Address - Street 1:4915 E BASELINE RD STE 123
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2969
Practice Address - Country:US
Practice Address - Phone:680-248-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ264821363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner