Provider Demographics
NPI:1689292468
Name:YEPIZ, CALISSA LEIGH (MSN, APRN PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CALISSA
Middle Name:LEIGH
Last Name:YEPIZ
Suffix:
Gender:F
Credentials:MSN, APRN PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 W MELINDA LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9591
Mailing Address - Country:US
Mailing Address - Phone:602-639-1693
Mailing Address - Fax:
Practice Address - Street 1:13760 N 93RD AVE STE 111
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4250
Practice Address - Country:US
Practice Address - Phone:602-960-7795
Practice Address - Fax:602-584-5008
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ243995363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health