Provider Demographics
NPI:1023499860
Name:SCHULTZ, KELLY LYNN (DNP RN AGNP-C)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNN
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:DNP RN AGNP-C
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4022 E GREENWAY ROAD
Mailing Address - Street 2:SUITE 11-180
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5245
Mailing Address - Country:US
Mailing Address - Phone:866-263-3820
Mailing Address - Fax:866-857-9967
Practice Address - Street 1:4555 E MAYO BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-6952
Practice Address - Country:US
Practice Address - Phone:480-384-5816
Practice Address - Fax:480-384-5678
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7895163WW0000X, 363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty