Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JESSE HEADAPOHL FATOMA
ActivePsychiatric/Mental Health Nurse · AVONDALE, AZ
Registration Details
- NPI Number
- 1407743891
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jun 19, 2025 (0.84162594776931 yrs)
- Last Updated
- Jun 19, 2025
- Licenses
-
RN204116 (AZ)RN204116 (AZ)
Practice Information
- Address
-
11770 W DAVIS LNAVONDALE, AZ, 853237695Browse AZ providers · Browse ZIP 85323
- Phone
- 4802178964
- Primary Specialty
-
Psychiatric/Mental Health Nurse
163WP0807X
- Additional Specialty
- Psychiatric/Mental Health Nurse
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.