| Athena Medical Group | |
|
16515 S 40th St Ste 143 Phoenix AZ 85048-0560 | |
| (480) 712-8319 | |
| (480) 712-1305 |
| Full Name | Athena Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 16515 S 40th St Ste 143, Phoenix, Arizona |
| Authorized Official Name and Position | Yancey Scott Gaither (MANAGING PARTNER) |
| Authorized Official Contact | 4807128319 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Athena Medical Group 16515 S 40th St Ste 143 Phoenix AZ 85048-0560 Ph: (480) 712-8319 | Athena Medical Group 16515 S 40th St Ste 143 Phoenix AZ 85048-0560 Ph: (480) 712-8319 |
| NPI Number | 1164918124 |
|---|---|
| Provider Enumeration Date | 07/02/2018 |
| Last Update Date | 08/20/2024 |
| Medicare PECOS PAC ID | 8921358706 |
|---|---|
| Medicare Enrollment ID | O20180829003049 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164918124 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| Provider Name | Renee Yvonne Kellems |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659746071 PECOS PAC ID: 6002118866 Enrollment ID: I20160111001826 |
| Provider Name | Marianne Nga Parham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679876031 PECOS PAC ID: 2062708357 Enrollment ID: I20160913001959 |
| Provider Name | Teresa Marie Gaither |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568835890 PECOS PAC ID: 9931480985 Enrollment ID: I20170105000804 |
| Provider Name | Sanna Neff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083150205 PECOS PAC ID: 4789969858 Enrollment ID: I20170403000763 |
| Provider Name | Tyler Ann Brockhoff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003347147 PECOS PAC ID: 6406132778 Enrollment ID: I20170421000681 |
| Provider Name | Jonathan Glenn Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407381189 PECOS PAC ID: 8527330596 Enrollment ID: I20170825001772 |
| Provider Name | Jennifer Otterbein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467425751 PECOS PAC ID: 8729042338 Enrollment ID: I20201020000267 |
| Provider Name | Deborah A Gorombei |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194492306 PECOS PAC ID: 1557750262 Enrollment ID: I20211118002774 |
| Provider Name | Danielle Nathina Sears |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174279509 PECOS PAC ID: 7618363649 Enrollment ID: I20220331000453 |
| Provider Name | Taylor Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881333110 PECOS PAC ID: 0648655563 Enrollment ID: I20220913003413 |
| Provider Name | Megan Gerene Vettorel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215659644 PECOS PAC ID: 3476929084 Enrollment ID: I20221024001791 |
| Provider Name | Joy Pollard-stoiber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588392336 PECOS PAC ID: 1557731528 Enrollment ID: I20230109001138 |
| Provider Name | Kristin S Landavazo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598420846 PECOS PAC ID: 9638535081 Enrollment ID: I20230510001183 |
| Provider Name | Valentina None Scalzullo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457053456 PECOS PAC ID: 9335593441 Enrollment ID: I20230922003024 |
| Provider Name | Allison Putt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679356083 PECOS PAC ID: 6406203645 Enrollment ID: I20231109003288 |
| Provider Name | Kimberly Jenkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760249247 PECOS PAC ID: 3870035843 Enrollment ID: I20240605002044 |
| Provider Name | Yushma Pant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487433355 PECOS PAC ID: 1153856950 Enrollment ID: I20241202003271 |
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