Provider Demographics
NPI:1326561499
Name:HAZEL, KELLEY (CNM)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:HAZEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 748860
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374
Mailing Address - Country:US
Mailing Address - Phone:480-821-3600
Mailing Address - Fax:480-821-3610
Practice Address - Street 1:3530 S VAL VISTA DR STE 203
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7322
Practice Address - Country:US
Practice Address - Phone:480-917-6480
Practice Address - Fax:480-857-2667
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2023-06-26
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife