Provider Demographics
NPI:1386071611
Name:OLSON, KYLIE (FNP-C)
Entity type:Individual
Prefix:MISS
First Name:KYLIE
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9377 E BELL RD
Mailing Address - Street 2:SUITE 143
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1502
Mailing Address - Country:US
Mailing Address - Phone:480-619-4097
Mailing Address - Fax:
Practice Address - Street 1:9377 E BELL RD
Practice Address - Street 2:SUITE 143
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1502
Practice Address - Country:US
Practice Address - Phone:480-619-4097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily