Provider Demographics
NPI:1174633051
Name:CORREA, CHARITY MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:MARIE
Last Name:CORREA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:M
Other - Last Name:KINCADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:36590 N BOULDER VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-3909
Mailing Address - Country:US
Mailing Address - Phone:602-449-2811
Mailing Address - Fax:602-449-2812
Practice Address - Street 1:6601 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-5700
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:623-247-9742
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4512363LP2300X, 363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ763934Medicaid