Healthcare Provider Details

I. General information

NPI: 1124673272
Provider Name (Legal Business Name): MACKENZIE ANN KELBEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19555 N 59TH AVE
GLENDALE AZ
85308
US

IV. Provider business mailing address

322 SKYLINE DR
PETOSKEY MI
49770-8650
US

V. Phone/Fax

Practice location:
  • Phone: 623-572-3215
  • Fax:
Mailing address:
  • Phone: 231-881-1795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7697
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: