Provider Demographics
NPI:1700640885
Name:MULHOLLAND, KELLY MARIE (NP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:MULHOLLAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 29650, DEPT # 880391
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-2690
Mailing Address - Country:US
Mailing Address - Phone:480-626-1746
Mailing Address - Fax:480-626-2690
Practice Address - Street 1:6036 N 19TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2104
Practice Address - Country:US
Practice Address - Phone:480-616-0356
Practice Address - Fax:480-616-0603
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ301586363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily