Provider Demographics
NPI:1043895030
Name:HEFFRON, KELLY LYNN (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNN
Last Name:HEFFRON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
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Mailing Address - Street 1:16620 N 40TH ST STE E1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3357
Mailing Address - Country:US
Mailing Address - Phone:602-464-9576
Mailing Address - Fax:602-626-8901
Practice Address - Street 1:13331 W INDIAN SCHOOL RD STE B203
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4340
Practice Address - Country:US
Practice Address - Phone:623-269-3990
Practice Address - Fax:623-269-3924
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ255426363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health