Individual
MRS. KAY LYNN SOUTHWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC,NPC
Contact information
Practice address
1910 S STAPLEY DR STE 217, MESA, AZ 85204-6679
(602) 888-0370
Mailing address
7156 E OLLA AVE, MESA, AZ 85212-9802
(810) 919-6247
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP8742
AZ
363LP2300X
Primary Care Nurse Practitioner
4704216251
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0B56065
MEDICARE PART B
AZ
01
—
0B56065
MEDICARE PART B
MI
Enumeration date
03/23/2009
Last updated
09/30/2024
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