# HEARTFIT FOR DUTY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801139712
- **Authorized official:** KEPRA L JACK (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (480) 999-7911

## Contact information

- **Practice address:** 633 E RAY RD, SUITE 101, GILBERT, AZ 85296-4200
- **Practice address phone:** (480) 999-7911
- **Practice address fax:** (480) 499-5829
- **Mailing address:** 633 E RAY RD, SUITE 101, GILBERT, AZ 85296-4200
- **Mailing address phone:** (480) 999-7911
- **Mailing address fax:** (480) 499-5829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/28/2013
- **Last updated:** 03/29/2013