MEDICARE: MS. KELLI MICHELE FABELA P.A.-C

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	4504	AZ

General Provider Information

NPI Number	:	1588990345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLI MICHELE FABELA P.A.-C

Provider Business Mailing Address
First Line	:	6539 N 175TH LN
Second Line	:
City	:	WADDELL
State	:	AZ
Zip	:	85355-9477
Country	:	US
Telephone Number	:	480-270-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 N 19TH AVE STE 121
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-2901
Country	:	US
Telephone Number	:	602-433-1822
Fax Number	:

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

Provider Enumeration Date	:	10/28/2009
Last Update Date	:	03/20/2024

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Directions to “ MS. KELLI MICHELE FABELA P.A.-C” Practice Location

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