MEDICARE: KAITLIN M BEADLES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	8161	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Z120390	OTHER	AZ	PTAN

General Provider Information

NPI Number	:	1174141238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN M BEADLES PA

Provider Business Mailing Address
First Line	:	645 E MISSOURI AVE STE 280
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1349
Country	:	US
Telephone Number	:	602-264-9100
Fax Number	:	602-264-9101

Provider Business Practice Location Address
First Line	:	9305 W THOMAS RD STE 370
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-3367
Country	:	US
Telephone Number	:	602-266-5678
Fax Number	:	602-264-5646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	09/18/2023

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Directions to “ KAITLIN M BEADLES PA” Practice Location

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