Provider Demographics
NPI:1750974960
Name:VERDE VALLEY CONCIERGE MEDICINE PLLC
Entity type:Organization
Organization Name:VERDE VALLEY CONCIERGE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:KEABLE
Authorized Official - Suffix:
Authorized Official - Credentials:AGACNP-BC
Authorized Official - Phone:928-852-4540
Mailing Address - Street 1:203 S CANDY LN STE 1A
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-8104
Mailing Address - Country:US
Mailing Address - Phone:928-852-4540
Mailing Address - Fax:877-832-2119
Practice Address - Street 1:203 S CANDY LN STE 1A
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-8104
Practice Address - Country:US
Practice Address - Phone:928-852-4540
Practice Address - Fax:877-832-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty