Healthcare Provider Details

I. General information

NPI: 1134901671
Provider Name (Legal Business Name): OLIVIA KIEFFER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6828 E BROWN RD STE 102
MESA AZ
85207-3761
US

IV. Provider business mailing address

PO BOX 24981
BELFAST ME
04915-2000
US

V. Phone/Fax

Practice location:
  • Phone: 602-755-0800
  • Fax: 602-560-2721
Mailing address:
  • Phone: 844-969-0686
  • Fax: 773-832-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.PA.61484555
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10570
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: