Healthcare Provider Details

I. General information

NPI: 1669983045
Provider Name (Legal Business Name): KAITLIN JOY KUEHNE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATLIN JOY LAYMAN PA-C

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S CHANDLER VILLAGE DR
CHANDLER AZ
85226-5069
US

IV. Provider business mailing address

PO BOX 80217
PHOENIX AZ
85060-0217
US

V. Phone/Fax

Practice location:
  • Phone: 602-648-5444
  • Fax: 602-772-3801
Mailing address:
  • Phone: 602-385-2115
  • Fax: 480-418-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110776
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9140
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberPA9110776
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: