Provider Demographics
NPI:1245282847
Name:SKELTON, MYUNG MEE (ANP)
Entity type:Individual
Prefix:MS
First Name:MYUNG
Middle Name:MEE
Last Name:SKELTON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MS
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:SKELTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP
Mailing Address - Street 1:648 E SHEFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4115
Mailing Address - Country:US
Mailing Address - Phone:480-756-9537
Mailing Address - Fax:
Practice Address - Street 1:2025 N 3RD ST
Practice Address - Street 2:SUITE 170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1471
Practice Address - Country:US
Practice Address - Phone:602-462-1132
Practice Address - Fax:602-462-1135
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN111998363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ122089 & Z122090OtherPTAN MEDICARE ID