Provider Demographics
NPI:1881796852
Name:KEARNEY, MARIE PATRICIA (RN ANP CGNP)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:PATRICIA
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:RN ANP CGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35637
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740
Mailing Address - Country:US
Mailing Address - Phone:520-690-4567
Mailing Address - Fax:520-323-8252
Practice Address - Street 1:3953 E PARADISE FALLS DR STE 110
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6689
Practice Address - Country:US
Practice Address - Phone:520-323-0401
Practice Address - Fax:520-323-0901
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN044028363LA2200X
AZANP #91363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z141901Medicare UPIN