Provider Demographics
NPI:1437541091
Name:GRIFFIN, KELLY DENISE (APRN FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:DENISE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 OLD DIARY RD
Mailing Address - Street 2:
Mailing Address - City:JUNEU
Mailing Address - State:AK
Mailing Address - Zip Code:99801
Mailing Address - Country:US
Mailing Address - Phone:907-790-4111
Mailing Address - Fax:907-790-3111
Practice Address - Street 1:8505 OLD DIARY RD
Practice Address - Street 2:
Practice Address - City:JUNEU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-790-4111
Practice Address - Fax:907-790-3111
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN104391163W00000X
AZAP7749363LF0000X
AK202259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ016759Medicaid
03-1815OtherMEDICARE
ZFQ31815OtherMEDICARE
AZ912044Medicaid
AK1737735Medicaid