Provider Demographics
NPI:1922110790
Name:KEKKONEN, KAREN O (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:O
Last Name:KEKKONEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:O
Other - Last Name:KEKKONEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:4233 W CAMINO VIVAZ
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5576
Mailing Address - Country:US
Mailing Address - Phone:602-826-0900
Mailing Address - Fax:602-936-0344
Practice Address - Street 1:4233 W CAMINO VIVAZ
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-5576
Practice Address - Country:US
Practice Address - Phone:602-826-0900
Practice Address - Fax:602-936-0344
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAPN1201363LF0000X
AZ102304363LP2300X
AZAP1201363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily