Provider Demographics
NPI:1316506561
Name:RANAHAN, KELLY A (FNP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:A
Last Name:RANAHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:RANAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:1684 E BOSTON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3458 E PARK AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-4217
Practice Address - Country:US
Practice Address - Phone:480-341-8202
Practice Address - Fax:602-584-6460
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ227296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily