Provider Demographics
NPI:1982476222
Name:LAUGHLIN, KELLY (DNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LAUGHLIN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 W BERRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1427
Mailing Address - Country:US
Mailing Address - Phone:623-695-9204
Mailing Address - Fax:
Practice Address - Street 1:1324 W BERRIDGE LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1427
Practice Address - Country:US
Practice Address - Phone:623-695-9204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP301031363LP0808X
AZRN137266163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health