Provider Demographics
NPI:1396120648
Name:FLEMING, KELLY (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:FLEMING
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 1:1200 N EL DORADO PL STE D400
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4637
Mailing Address - Country:US
Mailing Address - Phone:520-289-8081
Mailing Address - Fax:520-289-8082
Practice Address - Street 1:1200 N EL DORADO PL STE D400
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4637
Practice Address - Country:US
Practice Address - Phone:520-289-8081
Practice Address - Fax:520-289-8082
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8743363LF0000X
CO0169154163W00000X
VA0024172810363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse