Provider Demographics
NPI:1104461508
Name:KABYEMELA, MICHAEL (NP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KABYEMELA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 E FLOWER ST BLDG 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5656
Mailing Address - Country:US
Mailing Address - Phone:480-268-2670
Mailing Address - Fax:877-268-2671
Practice Address - Street 1:1510 E FLOWER ST BLDG 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5656
Practice Address - Country:US
Practice Address - Phone:480-268-2670
Practice Address - Fax:877-268-2671
Is Sole Proprietor?:No
Enumeration Date:2019-11-10
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ234156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily