Provider Demographics
NPI:1659037265
Name:CASTILLO, AMY MICHELL (DNP-PMHNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELL
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:DNP-PMHNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MICHELL
Other - Last Name:KISNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP-PMHNP
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-4111
Mailing Address - Fax:520-616-1442
Practice Address - Street 1:13395 N MARANA MAIN ST BLDG B
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-7008
Practice Address - Country:US
Practice Address - Phone:520-682-1091
Practice Address - Fax:520-682-4132
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ233428363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ123625Medicaid