Healthcare Provider Details

I. General information

NPI: 1063289049
Provider Name (Legal Business Name): KARLEE KREBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6553 E BAYWOOD AVE STE 101
MESA AZ
85206-1753
US

IV. Provider business mailing address

6553 E BAYWOOD AVE STE 101
MESA AZ
85206-1753
US

V. Phone/Fax

Practice location:
  • Phone: 480-543-6750
  • Fax: 480-543-5907
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10686
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: