Provider Demographics
NPI:1013514421
Name:ADAMS, TODD A (APRN)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:A
Last Name:ADAMS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40434 N CANDLEWYCK LN
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-2910
Mailing Address - Country:US
Mailing Address - Phone:859-537-3530
Mailing Address - Fax:
Practice Address - Street 1:41818 N VENTURE DR STE 150
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3190
Practice Address - Country:US
Practice Address - Phone:623-400-1501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY58169363LP0808X
AZ2507762084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine