Provider Demographics
NPI:1790461408
Name:BELLOWS, KELBY LYNN (CNM, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:KELBY
Middle Name:LYNN
Last Name:BELLOWS
Suffix:
Gender:F
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9203 W GARY RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-5526
Mailing Address - Country:US
Mailing Address - Phone:623-512-9207
Mailing Address - Fax:
Practice Address - Street 1:6707 N 19TH AVE STE 222
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1106
Practice Address - Country:US
Practice Address - Phone:602-283-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCNM08658367A00000X
AZ104956648363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife