Basic Information
| Provider Information | |||||||||
| NPI: | 1306062781 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUHN | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, MSN, FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JENKINS | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 900 W SCOTT ST | ||||||||
| Address2: | |||||||||
| City: | WILLCOX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856431017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203844421 | ||||||||
| FaxNumber: | 5203844645 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 W SCOTT ST | ||||||||
| Address2: | |||||||||
| City: | WILLCOX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856431017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203844421 | ||||||||
| FaxNumber: | 5203844645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 12/01/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN115452 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 227218 | 05 | AZ | MEDICAID |