Individual
MARY GAY KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
12425 W BELL RD, SUITE 200, SURPRISE, AZ 85378-9006
(623) 374-7774
(623) 240-1110
Mailing address
12425 W BELL RD, SUITE 200, SURPRISE, AZ 85378-9006
(623) 374-7774
(623) 240-1110
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
AP2547
AZ
363LG0600X
Gerontology Nurse Practitioner
Primary
AP0029
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
293709
—
AZ
01
—
P00457902
MEDICARE RR
AZ
Enumeration date
09/02/2005
Last updated
07/11/2011
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