Provider Demographics
NPI:1881752038
Name:GROGAN, KELLY RENEE (NP)
Entity type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:RENEE
Last Name:GROGAN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1910 E THOMAS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7767
Mailing Address - Country:US
Mailing Address - Phone:602-266-2200
Mailing Address - Fax:602-604-5032
Practice Address - Street 1:1910 E THOMAS RD STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7767
Practice Address - Country:US
Practice Address - Phone:602-266-2200
Practice Address - Fax:602-604-6134
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2019-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZRN066578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily