Provider Demographics
NPI:1700399839
Name:KENT, MARK ROY (FNP-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ROY
Last Name:KENT
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1343 N ALMA SCHOOL RD
Mailing Address - Street 2:STE 160
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5901
Mailing Address - Country:US
Mailing Address - Phone:480-963-1853
Mailing Address - Fax:480-963-1854
Practice Address - Street 1:3312 E DESERT MOON TRL
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-3352
Practice Address - Country:US
Practice Address - Phone:520-390-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-11
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP10730363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily