Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Carissa Ann Gaddie

Individual provider Family Nurse Practitioner · NPI 1700617008

Carissa Ann Gaddie is a Nurse Practitioner in Phoenix, Arizona. Qualified in 2024, 2 years ago. Practices with Banner - University Super Specialists LLC, a 32-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Arizona.

Years since qualifying
2
Licensed in
AZ
In the registry since
2024
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Practice location Address checks out

1441 N 12th St
Phoenix, AZ 85006-2837
Phone: (602) 521-5900
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 255495 (AZ)

Record details

NPI number1700617008
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedAugust 9, 2024
Last updated in NPPESAugust 9, 2024
Certification dateAugust 7, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Banner - University Super Specialists Llc — 32 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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