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Organization
KAIROS MOMENT HEALTHCARE AND BEHAVIORAL CLINIC - LLC
Active
Organization
KAIROS MOMENT HEALTHCARE AND BEHAVIORAL CLINIC - LLC
Active
Other names
Kairos Moment Healthcare and Behavioral Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ADESOLA IZASOMEH PMHNP - BC (NURSE PRACTITIONER)
(602) 410-0958
Entity
Organization
Contact information
Practice address
9652 W PATRICK LN, PEORIA, AZ 85383-4319
(602) 410-0958
Mailing address
9652 W PATRICK LN, PEORIA, AZ 85383-4319
(602) 410-0958
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
09/26/2023
Last updated
10/28/2024
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