Provider Demographics
NPI:1790176634
Name:HUNTER, KELCI (NP)
Entity Type:Individual
Prefix:
First Name:KELCI
Middle Name:
Last Name:HUNTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17235 N 75TH AVE STE C125
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0879
Mailing Address - Country:US
Mailing Address - Phone:623-277-7761
Mailing Address - Fax:
Practice Address - Street 1:17235 N 75TH AVE STE C125
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-0879
Practice Address - Country:US
Practice Address - Phone:623-277-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN20412OtherSTATE LICENSE