| Priority Family Medical Clinic Llc | |
|
3165 Stillwater Dr Prescott AZ 86305-7173 | |
| (928) 277-0875 | |
| (928) 379-5177 |
| Full Name | Priority Family Medical Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3165 Stillwater Dr, Prescott, Arizona |
| Authorized Official Name and Position | Thomas Judah Gann (NURSE PRACTITIONER) |
| Authorized Official Contact | 9282770875 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Priority Family Medical Clinic Llc 3165 Stillwater Dr Prescott AZ 86305-7173 Ph: (928) 277-0875 | Priority Family Medical Clinic Llc 3165 Stillwater Dr Prescott AZ 86305-7173 Ph: (928) 277-0875 |
| NPI Number | 1205309812 |
|---|---|
| Provider Enumeration Date | 01/07/2019 |
| Last Update Date | 10/25/2022 |
| Medicare PECOS PAC ID | 1850632019 |
|---|---|
| Medicare Enrollment ID | O20190416002369 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205309812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Brenda A Austin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013959964 PECOS PAC ID: 6305882119 Enrollment ID: I20050701000466 |
| Provider Name | Eileen I Mahler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922438563 PECOS PAC ID: 9830321090 Enrollment ID: I20140422002153 |
| Provider Name | Thomas J Gann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073866406 PECOS PAC ID: 9234383258 Enrollment ID: I20141107002001 |
| Provider Name | Sarah B Claussen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255983334 PECOS PAC ID: 6800220294 Enrollment ID: I20191217002501 |
| Provider Name | Dionne Louise Shy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336757731 PECOS PAC ID: 2163847492 Enrollment ID: I20200804002510 |
| Provider Name | Kayleigh R Nissle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740883495 PECOS PAC ID: 3274945563 Enrollment ID: I20201210000532 |
| Provider Name | Kenna Jan Stephenson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962697755 PECOS PAC ID: 2860570033 Enrollment ID: I20211013001513 |
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