Provider Demographics
NPI:1477261709
Name:KILPATRICK, STACI P (FNP)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:P
Last Name:KILPATRICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 S SAILORS REEF RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2135
Mailing Address - Country:US
Mailing Address - Phone:602-717-0231
Mailing Address - Fax:
Practice Address - Street 1:5609 S SAILORS REEF RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2135
Practice Address - Country:US
Practice Address - Phone:602-717-0231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ283666363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner