Healthcare Provider Details

I. General information

NPI: 1144969320
Provider Name (Legal Business Name): KYLIE TRUNCELLITO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE STE 205
PHOENIX AZ
85016-4876
US

IV. Provider business mailing address

16176 W POINSETTIA DR
SURPRISE AZ
85379-1127
US

V. Phone/Fax

Practice location:
  • Phone: 602-358-8588
  • Fax: 602-688-6991
Mailing address:
  • Phone: 623-302-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9312
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: