Provider Demographics
NPI:1720214323
Name:LITTLETON, KELLY LYNN (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNN
Last Name:LITTLETON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10645 N ORACLE RD STE 121-348
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9387
Mailing Address - Country:US
Mailing Address - Phone:520-468-8841
Mailing Address - Fax:520-722-9669
Practice Address - Street 1:1735 E FORT LOWELL RD STE 9
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2358
Practice Address - Country:US
Practice Address - Phone:520-468-8841
Practice Address - Fax:520-722-9669
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3444363LA2100X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ559989Medicaid
AZ559989Medicaid